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A brain-based pain facilitation mechanism contributes to painful diabetic polyneuropathy
Brain ( IF 14.5 ) Pub Date : 2018-01-15 , DOI: 10.1093/brain/awx337
Andrew R Segerdahl 1 , Andreas C Themistocleous 2 , Dean Fido 1 , David L Bennett 2 , Irene Tracey 1
Affiliation  

The descending pain modulatory system represents one of the oldest and most fundamentally important neurophysiological mechanisms relevant to pain. Extensive work in animals and humans has shown how a functional imbalance between the facilitatory and inhibitory components is linked to exacerbation and maintenance of persistent pain states. Forward translation of these findings into clinical populations is needed to verify the relevance of this imbalance. Diabetic polyneuropathy is one of the most common causes of chronic neuropathic pain; however, the reason why ∼25–30% of patients with diabetes develop pain is not known. The current study used a multimodal clinical neuroimaging approach to interrogate whether the sensory phenotype of painful diabetic polyneuropathy involves altered function of the ventrolateral periaqueductal grey—a key node of the descending pain modulatory system. We found that ventrolateral periaqueductal grey functional connectivity is altered in patients suffering from painful diabetic polyneuropathy; the magnitude of which is correlated to their spontaneous and allodynic pain as well as the magnitude of the cortical response elicited by an experimental tonic heat paradigm. We posit that ventrolateral periaqueductal grey-mediated descending pain modulatory system dysfunction may reflect a brain-based pain facilitation mechanism contributing to painful diabetic polyneuropathy.

中文翻译:

基于脑的疼痛促进机制促成糖尿病性多发性神经痛

下行疼痛调节系统代表了与疼痛有关的最古老,最根本的重要神经生理机制之一。在动物和人类中进行的大量工作表明,促进性成分和抑制性成分之间的功能失衡如何与持续性疼痛状态的加剧和维持有关。需要将这些发现转发给临床人群,以验证这种不平衡的相关性。糖尿病多发性神经病是慢性神经性疼痛的最常见原因之一。但是,尚不清楚约25–30%的糖尿病患者会出现疼痛的原因。当前的研究使用了一种多模式临床神经影像学方法来询问疼痛性糖尿病多发性神经病的感觉表型是否涉及腹侧导水管周围灰色的功能改变,而腹侧导水管周围的灰色是降痛调节系统的关键节点。我们发现,患有糖尿病性多发性神经痛的患者腹侧导水管周围灰色功能连接改变。其强度与它们的自发性和异常性疼痛以及由实验性进补热范例引起的皮质反应的强度有关。我们认为腹外侧导水管周围介导的降痛调节系统功能障碍可能反映了基于脑的疼痛促进机制,该机制促进了糖尿病性多发性神经痛。我们发现,患有糖尿病性多发性神经痛的患者腹侧导水管周围灰色功能连接改变。其强度与它们的自发性和异常性疼痛以及由实验性进补热范例引起的皮质反应的强度有关。我们认为腹外侧导水管周围介导的降痛调节系统功能障碍可能反映了基于脑的疼痛促进机制,该机制促进了糖尿病性多发性神经痛。我们发现,患有糖尿病性多发性神经痛的患者腹侧导水管周围灰色功能连接改变。其强度与它们的自发性和异常性疼痛以及由实验性进补热范例引起的皮质反应的强度有关。我们认为腹外侧导水管周围介导的降痛调节系统功能障碍可能反映了基于脑的疼痛促进机制,该机制促进了糖尿病性多发性神经痛。
更新日期:2018-01-15
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