Objective: To investigate brain structural changes involved in chronic pain in patients with pain due to brachial plexus avulsion, voxel-based morphometry was used to determine the brain gray matter changes . Methods: Ten right-handed patients with chronic pain due to left brachial plexus avulsion, whose pain reduced more than 75% after DREZotomy, and ten right-handed age- and sex-matched healthy control subjects participated inparticipated in the study. VAS, HADD and HADA were recorded before and 6 months after DREZotomy, respectively. Statistical parametric mapping 5 was applied for data analysis. Results: Compared with healthy subjects, the patients had gray matter decreases in the periaoueductal gray matter (PAG) and ipsilateral hippocampus, and significant gray matter increases in the ipsilateral anterior cingulate cortex (ACC) (BA24), the contralateral inferior frontal cortex (BA47). Comparing with patients during pain before DREZotomy, VBM analysis after DREZotomy showed there were no, significant gray matters changes.Conclusion: These findings suggest that chronic pain is associated with cortical and subcortical reorganization on a structural level, which may play an important role in the process of the chronication of pain in patients with pain due to brachial plexus avulsion.%目的:应用基于体素的形态学分析技术探讨臂丛神经撕脱伤后疼痛患者与慢性疼痛相关的脑结构改变.方法:选择左侧臂丛神经撕脱伤后慢性疼痛,行脊髓背根入髓区切开术后疼痛减轻＞75％的患者,共10例,以及10例性别和年龄匹配的健康志愿者纳入研究.疼痛患者分别在术前和术后半年采集MRI数据,同时行视觉模拟评分(VAS),汉密尔顿抑郁(HADD)和焦虑评分(HADA).用统计参数图5( SPM5)软件分析数据.结果:与健康志愿者相比,在臂丛神经撕脱伤后慢性疼痛患者中,灰质容积减低的脑区为中央导水管周围灰质和患肢同侧的海马；灰质容积增高的脑区为患肢同侧的前扣带回( BA24)、对侧的额下回(BA47).而术前疼痛和术后半年疼痛消失的两组之间比较发现,臂丛神经撕脱伤后疼痛患者的脑区结构无明显改变.结论:研究提示臂丛神经撕脱伤后慢性疼痛患者存在皮层或皮层下脑组织结构上的重组,这些改变可能在疼痛的慢性化中发挥作用.
展开▼
