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首页> 外文期刊>Psychosomatic Medicine: Journal of the American Psychosomatic Society >Illness behavior in patients with chronic low back pain and activation of the affective circuitry of the brain
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Illness behavior in patients with chronic low back pain and activation of the affective circuitry of the brain

机译：慢性下腰痛患者的疾病行为和大脑情感回路的激活

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OBJECTIVE: Patients with chronic low back pain (cLBP) show a range of behavioral patterns that do not correlate with degree of spinal abnormality found in clinical, radiological, neurophysiological, or laboratory investigations. This may indicate an augmented central pain response, consistent with factors that mediate and maintain psychological distress in this group. METHODS: Twenty-four cLBP patients were scanned with functional magnetic resonance imaging while receiving noxious thermal stimulation to the right hand. Patients were clinically assessed into those with significant pain-related illness behavior (Waddell signs [WS]-H) or without (WS-L) based on WS. RESULTS: Our findings revealed a significant increase in brain activity in WS-H versus WS-L patients in response to noxious heat in the right amygdala/parahippocampal gyrus and ventrolateral prefrontal and insular cortex (at a VoxelPThreshold = 0.01). We found no difference between groups for heat pain thresholds (t(22) = -1.17, p = .28) or sensory-discriminative pain regions. CONCLUSIONS: Patients with cLBP displaying major pain behavior have increased activity in the emotional circuitry of the brain. This study is the first to suggest an association between a specific clinical test in cLBP and neurobiology of the brain. Functional magnetic resonance imaging may provide a tool capable of enhancing diagnostic accuracy and affecting treatment decisions in cases where no structural cause can be identified.
机译：目的：患有慢性下腰痛（cLBP）的患者表现出一系列与临床，放射学，神经生理学或实验室研究中发现的脊柱异常程度无关的行为模式。这可能表明中枢性疼痛反应增强，与调解和维持该组心理困扰的因素一致。方法：24例cLBP患者在接受右手有害热刺激的同时进行了功能磁共振成像扫描。根据WS对患者进行临床评估，评估其是否具有明显的疼痛相关疾病行为（Waddell征兆[WS] -H）或无（WS-L）。结果：我们的研究结果表明，WS-H与WS-L患者的大脑活动显着增加，这是由于右侧杏仁核/海马旁回和腹外侧前额叶和小岛皮层的有害热量引起的（VoxelPThreshold = 0.01）。我们发现两组之间在热痛阈值（t（22）= -1.17，p = .28）或感觉辨别性疼痛区域上没有差异。结论：cLBP患者表现出严重的疼痛行为，其大脑的情感回路活动增加。这项研究首次提出了cLBP的特定临床测试与大脑神经生物学之间的关联。功能磁共振成像可提供一种工具，能够在无法识别出结构原因的情况下提高诊断准确性并影响治疗决策。

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