课件：抑郁症神经基础研究.ppt

* PURPOSE OF THE SLIDE Transition to structural changes that may be observed in gray matter in patients with chronic pain conditions. KEY POINTS This is the first study showing brain structural changes in patients with chronic pain. 26 patients fulfilling the International Association for the Study of Pain (IASP) criteria for CBP with pain duration of at least 1 year were compared with 26 matched volunteers. The source of CBP was not distinguished, although the main source of pain was lumbosacral. Voxel-based morphometry (VBM) has been validated against other standard measures. Images were first normalized into a standard space and then segmented. Voxel values reflect absolute amounts (volume in arbitrary units) of gray matter. In the voxel-based morphometry (VBM) image on the left, gray matter density is bilaterally reduced in the dorsolateral PFC. These observed changes likely constitute the cognitive and behavioral properties (pain perception) of chronic pain. At right: a significant decrease in gray matter density was observed in the right anterior thalamus. The left thalamus also showed a decrease in gray matter density; however, this decrease did not pass the significant threshold. The thalamus has an importance in mediating nociceptive inputs to the cortex. All told, patients with chronic back pain (CBP) had 5-11% less neocortical gray matter volume, similar to the effects of 10 to 20 years of normal aging compared to controls. The decrease in volume was related to pain duration, indicating a 1.3 cm3 loss of gray matter for every year of chronic pain. These are meaningful differences, though association cannot explain causality. The authors hypothesize that as atrophy of elements of the circuitry progresses, the pain condition becomes more irreversible and less responsive to therapy. REFERENCES Apkarian AV, Sosa Y, Sonty S, et al. Chronic back pain is associated with decreased prefrontal and thalamic gray matter density. J Neurosci. 2004;24(46):10410-10415