【fMRI研究揭示大脑“疼痛控制图”：对针灸治痛有启示】 李永明博士 纽约中医论坛
2017/4/23 纽约TCM论坛

    

    

     据NIH补充整合健康中心消息，自然通迅杂志2017年2月6日发表了一篇该中心资助的疼痛研究文章，揭示了大脑控制疼痛的一些秘密。克罗拉多的科学家综合分析了8个功能核磁共振(fMRI)研究项目的结果，其中包括了183位健康人体的fMRI疼痛研究数据，总结出了一个复杂的人体大脑疼痛控制图(Signature)。简而言之，研究发现人体大脑有多个对疼痛的反应区域，分为三组：第一组对不同强度的疼痛刺激产生反应；第二组对心理因素产生反应(如对疼痛的期望、感知控制疼痛及条件反射控制疼痛等)；第三组区域的反应可以抑制疼痛。另外一个发现是，大脑对疼痛的区域反应和控制似乎与疼痛的来源无关。

     这项重要的基础研究不但对理解复杂的疼痛机制有帮助，还为临床针灸治疗疼痛提供了重要启示。很可能是，针灸治疗疼痛的不同理论、方法及手法就是通过三组不同的区域产生作用。比如，硬针灸“以痛治痛”，可能作用于一区；软针灸“无痛治痛”，可能作用于二区；所有皮肤刺激都可能影响三区，出现“泛穴”现象；针灸的巨刺、缪刺、远端取穴法等所以有效，正是因为控制疼痛的中心在大脑，与疼痛的来源无关。另一个证据是，针刺治疗幻肢痛也有效。相信，对人体大脑的深入研究一定会揭开更多传统疗法的秘密。 (李永明)

    

     New Model Yields Fuller Picture of the Brain in Pain

     Using data from six independent studies, a multicenter team of researchers has created a functional MRI-based (fMRI) model that provides new ways of understanding and evaluating the neurobiological components of pain. The study, supported in part by the National Center for Complementary and Integrative Health, was led by scientists at the University of Colorado Boulder. It was published in the journal Nature Communications.

     It’s well established that the brain drives what people experience as pain. In the brain’s response to pain, the best-known process is “nociception,” in which the brain encodes and processes “noxious stimuli” (i.e., stimuli that injure or threaten to injure the body’s tissues, such as a heat stimulus in an experiment). In this new study, the investigators developed and tested a new, multi-level “signature,” using multivariate pattern analysis (which analyzes patterns in fMRI data) to quantitatively map brain activity and associated regions in pain, including those apart from nociception. They named it SIIPS1 (stimulus intensity independent pain signature-1).

     The researchers used data from six fMRI studies involving 183 healthy adults. In each study, participants, while inside an fMRI scanner, received a series of heat stimuli and then rated their related pain. Participants also underwent a psychological task relating to expectancy and/or perceived control over pain. The researchers then applied their signature to analyses of the study data and looked for commonalities.

     Across all trials, the researchers found activation of diverse brain regions involving pain: some sensitive to the intensity of nociceptive stimuli (such as the insula, cingulate cortex, and thalamus), and others that were insensitive to that intensity but rather were responsive to, or responsible for, the effects of psychological factors (such as expectations, perceived control of one’s own pain, and conditioning on perception of pain). These included the dorsomedial prefrontal cortex, the middle temporal gyrus, and the caudate and ventrolateral prefrontal cortex. In a third class of regions that included the ventromedial prefrontal cortex, the nucleus accumbens, the parahippocampal cortex, and the posterior dorsolateral prefrontal cortex, increased brain activity was associated with decreased pain. The new signature enabled integrated mapping of all these regions’ locations and contributions to pain. Innovatively, the team’s multivariate approach and relatively large (for fMRI studies) sample size permitted more precise, fine-grained mapping, and prediction of variations across the studies.

     The study authors noted that further testing and refinement of this signature is needed; however, it holds promise for use in combination with other models to understand and evaluate the many neurobiological components of pain and to obtain a fuller quantitative and physiological picture, including what happens to the brain over time in chronic pain. The findings also suggest that the new signature reflects potential pathways within the brain itself that may be independent of where the pain signals originate. This could help clinicians evaluate pain and researchers develop targeted treatments. A key innovation is that this signature could conceivably be used in clinical studies across different human populations and contexts—something not previously possible in this field.

     Reference

     Woo C-W, Schmidt L, Krishnan A, et al. Quantifying cerebral contributions to pain beyond nociception. Nature Communications. 2017;8:14211.

     February 14, 2017. Nature Communications. 2017;8:14211.

     February 14, 2017

     原文链接：

     https://nccih.nih.gov/research/results/spotlight/brain-in-pain?nav=govd

    

    

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