前额叶皮层在疼痛共情处理中的作用

Role of the Prefrontal Cortex in Pain Processing

摘要: 前额叶皮层(Prefrontal Cortex, PFC)在执行功能和疼痛处理中有重要作用，后者主要依赖于它与大脑新皮层、海马体、导水管周围灰质(PAG)、丘脑、杏仁核和基底核以及其他区域的连接。在处理急性和慢性疼痛时，PFC会发生神经递质、基因表达、胶质细胞和神经炎症的变化，导致其结构、活性发生改变。在处理疼痛时，起着双重作用，一方面感受刺激通过脑处理活动转化为知觉信号，然后知觉活动被用来控制传入的感觉刺激并传入中枢神经系统，它可能通过皮质纹状体投射诱导疼痛，这取决于腹侧被盖区通路中多巴胺受体激活(或缺乏)的水平。PFC还参与生物心理社会疼痛管理，这包括重复的经颅磁刺激、经颅直流电刺激、抗抑郁药、针灸、认知行为疗法、正念、音乐、锻炼、伴侣支持、共情、冥想和祈祷。研究证明了PFC在安慰剂镇痛中的作用，并在疼痛与抑郁、焦虑和认知功能障碍之间建立联系。特别是，在成功治疗慢性疼痛后，PFC灰质的损伤通常是可逆的。

Abstract: The prefrontal cortex (PFC) is important not only in executive function, but also in pain processing. The latter relies on its connections to the neocortex, hippocampus, periaquaductal gray (PAG), thalamus, amygdala and basal ganglia, among other areas of the brain. When dealing with acute and chronic pain, PFCs undergo changes in neurotransmitters, gene expression, glial cells, and neuroinflammation, leading to alterations in their structure, activity, and connectivity. Medial PFC (mPFC) probably plays dual and opposite roles in pain. Medial PFC (MPFC) mediates anti-injury effects due to its connections with other cortical regions and acts as a cortical afferent into PAG, a major source of pain regulation. This is a “cycle” in which sensory stimuli are converted into perceptual signals through brain processing activities, which are then used to control the flow of incoming sensory stimuli to the central nervous system at its entrance. It may induce chronization of pain via corticostriatal projection, depending on the level of dopamine receptor activation (or lack thereof) in the ventral tegmental pathway. PFCs are also involved in biopsychosocial pain management, which includes repetitive transcranial magnetic stimulation, transcranial direct current stimulation, antidepressants, acupuncture, cognitive behavioral therapy, mindfulness, music, exercise, partner support, empathy, meditation, and prayer. Studies have demonstrated the role of PFCs in placebo analgesia and established links between pain and depression, anxiety, and cognitive loss. In particular, damage to PFC gray matter is often reversible after successful treatment of chronic pain.