|Title:||fMRI evidence of degeneration-induced neuropathic pain in diabetes: Enhanced limbic and striatal activations||Authors:||MING-TSUNG TSENG
|Issue Date:||2013||Journal Volume:||34||Journal Issue:||10||Start page/Pages:||2733-2746||Source:||Human Brain Mapping||Abstract:||
Persistent neuropathic pain due to peripheral nerve degeneration in diabetes is a stressful symptom; however, the underlying neural substrates remain elusive. This study attempted to explore neuroanatomical substrates of thermal hyperalgesia and burning pain in a diabetic cohort due to pathologically proven cutaneous nerve degeneration (the painful group). By applying noxious 44°C heat stimuli to the right foot to provoke neuropathic pain symptoms, brain activation patterns were compared with those of healthy control subjects and patients with a similar degree of cutaneous nerve degeneration but without pain (the painless group). Psychophysical results showed enhanced affective pain ratings in the painful group. After eliminating the influence of different pain intensity ratings on cerebral responses, the painful group displayed augmented responses in the limbic and striatal structures, including the perigenual anterior cingulate cortex (ACC), superior frontal gyrus, medial thalamus, anterior insular cortex, lentiform nucleus (LN), and premotor area. Among these regions, blood oxygen level-dependent (BOLD) signals in the ACC and LN were correlated with pain ratings to thermal stimulations in the painful group. Furthermore, activation maps of a simple regression analysis as well as a region of interest analysis revealed that responses in these limbic and striatal circuits paralleled the duration of neuropathic pain. However, in the painless group, BOLD signals in the primary somatosensory cortex and ACC were reduced. These results suggest that enhanced limbic and striatal activations underlie maladaptive responses after cutaneous nerve degeneration, which contributed to the development and maintenance of burning pain and thermal hyperalgesia in diabetes. ? 2012 Wiley Periodicals, Inc.
|ISSN:||1065-9471||DOI:||10.1002/hbm.22105||SDG/Keyword:||adult; affect; aged; anterior cingulate; anterior insula; article; BOLD signal; brain function; brain nucleus; clinical article; controlled study; corpus striatum; cutaneous nerve degeneration; diabetic neuropathy; disease association; disease duration; female; functional magnetic resonance imaging; human; lentiform nucleus; limbic system; male; medial thalamus; nerve degeneration; neuropathic pain; nociceptive stimulation; pain assessment; peripheral neuropathy; premotor cortex; primary somatosensory cortex; priority journal; stimulus response; superior frontal gyrus; thalamus; contact heat-evoked potential; diabetes mellitus; functional magnetic resonance imaging; neuropathic pain; skin innervation; Adult; Aged; Brain Mapping; Corpus Striatum; Diabetes Mellitus, Type 2; Diabetic Neuropathies; Epidermis; Female; Gyrus Cinguli; Hot Temperature; Humans; Hyperalgesia; Hypesthesia; Limbic System; Magnetic Resonance Imaging; Male; Middle Aged; Nerve Degeneration; Neural Pathways; Neuralgia; Nociception; Nociceptive Pain; Pain; Pain Perception; Paresthesia; Peripheral Nerves
|Appears in Collections:||解剖學暨細胞生物學科所|
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