皮层感觉区和运动区的神经炎症激活与通过非可塑性机制维持的腰背痛患者的感觉运动功能有关：一项初步概念验证研究。

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain Pub Date : 2024-07-15 DOI:10.1002/ejp.2313

Muath A. Shraim, Hugo Massé-Alarie, Michael J. Farrell, Rocco Cavaleri, Marco L. Loggia, Paul W. Hodges

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引用次数: 0

摘要

背景：慢性疼痛涉及神经和免疫系统之间的交流。最近的数据表明，在慢性腰背痛（LBP）中，神经胶质（脑免疫细胞）的激活定位在大脑皮层的感觉运动区（S1/M1）。由于神经胶质细胞具有影响神经功能的多种功能，其活化可能会导致感觉运动的变化，尤其是在神经系统敏感性增加（即非痉挛性疼痛）的腰背痛患者中。这项初步概念验证研究旨在(i) 比较枸杞痛患者与非枸杞痛患者（以及痛觉型与非痛觉型枸杞痛表型）S1/M1 中神经炎症激活的证据，以及 (ii) 评估神经炎症激活与感觉运动功能之间的关系：同步 PET-fMRI 测量了无痛患者（n = 8）和慢性枸杞痛患者（n = 9；痛觉型：n = 4，非痛觉型：n = 5）功能定义的 S1/M1 中的神经炎症激活。在进行运动任务和热刺激时，使用 fMRI 鉴定与背部有关的 S1/M1 区域。感觉运动测量包括单脉冲和成对脉冲经颅磁刺激（TMS）和定量感觉测试（QST）。此外，还进行了睡眠、抑郁、残疾和疼痛问卷调查：结果：与痛觉性枸杞痛和无痛组相比，神经痉挛性枸杞痛组的下背部皮层 S1/M1 表征的神经炎症激活程度更高。S1/M1的神经炎症激活与对热痛（r = 0.52）和冷痛（r = 0.55）刺激的敏感性、睡眠质量差、抑郁、残疾和体重指数呈正相关，与皮质内促进呈负相关（r = -0.41）：结论：这项初步概念验证研究表明，非结节性枸杞痛患者背部S1/M1区域的神经炎症可以解释这种枸杞痛表型的一些特征：非痉挛性疼痛患者大脑感觉运动区域的神经炎症激活可能会导致感觉和运动功能的变化以及中枢敏感化。如果能在纵向研究中确定因果关系，就能指导开发针对神经炎症激活的疗法。

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Neuroinflammatory activation in sensory and motor regions of the cortex is related to sensorimotor function in individuals with low back pain maintained by nociplastic mechanisms: A preliminary proof-of-concept study

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Background

Chronic pain involves communication between neural and immune systems. Recent data suggest localization of glial (brain immune cells) activation to the sensorimotor regions of the brain cortex (S1/M1) in chronic low back pain (LBP). As glia perform diverse functions that impact neural function, activation might contribute to sensorimotor changes, particularly in LBP maintained by increased nervous system sensitivity (i.e., nociplastic pain). This preliminary proof-of-concept study aimed to: (i) compare evidence of neuroinflammatory activation in S1/M1 between individuals with and without LBP (and between nociceptive and nociplastic LBP phenotypes), and (ii) evaluate relationships between neuroinflammatory activation and sensorimotor function.

Methods

Simultaneous PET-fMRI measured neuroinflammatory activation in functionally defined S1/M1 in pain-free individuals (n = 8) and individuals with chronic LBP (n = 9; nociceptive: n = 4, nociplastic: n = 5). Regions of S1/M1 related to the back were identified using fMRI during motor tasks and thermal stimuli. Sensorimotor measures included single and paired-pulse transcranial magnetic stimulation (TMS) and quantitative sensory testing (QST). Sleep, depression, disability and pain questionnaires were administered.

Results

Neuroinflammatory activation was greater in the lower back cortical representation of S1/M1 of the nociplastic LBP group than both nociceptive LBP and pain-free groups. Neuroinflammatory activation in S1/M1 was positively correlated with sensitivity to hot (r = 0.52) and cold (r = 0.55) pain stimuli, poor sleep, depression, disability and BMI, and negatively correlated with intracortical facilitation (r = −0.41).

Conclusion

This preliminary proof-of-concept study suggests that neuroinflammation in back regions of S1/M1 in individuals with nociplastic LBP could plausibly explain some characteristic features of this LBP phenotype.

Significance Statement

Neuroinflammatory activation localized to sensorimotor areas of the brain in individuals with nociplastic pain might contribute to changes in sensory and motor function and aspects of central sensitization. If cause–effect relationships are established in longitudinal studies, this may direct development of therapies that target neuroinflammatory activation.

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来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.