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Kortikale Repräsentation von Schmerz

Cortical representation of pain

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Zusammenfassung

Entgegen der traditionellen Sichtweise, dass der zerebrale Kortex nicht an der Verarbeitung von Schmerz beteiligt sei, konnte in den letzten Jahrzehnten ein ausgedehntes kortikales Netzwerk Schmerz verarbeitender Areale gezeigt werden. Es umfasst insbesondere die primären (S1) und sekundären (S2) somatosensorischen Kortizes, den insulären Kortex und den vorderen zingulären Kortex (ACC). Diese Areale sind überwiegend parallel organisiert und verschiedenen qualitativen Aspekten der Schmerzwahrnehmung zuzuordnen. S1 ist mit der diskriminativen Komponente von Schmerz assoziiert, während S2 von besonderer Bedeutung für kognitive Aspekte der Schmerzwahrnehmung zu sein scheint. Dem Inselkortex wird eine entscheidende Rolle für die multimodale Integration und für autonome Reaktionen auf schmerzhafte Reize sowie schmerzbezogene Lern- und Gedächtnisvorgänge zugesprochen. Der ACC ist eng mit dem Schmerzaffekt und der Integration von Affekt, Kognition und motorischer Reaktion verbunden. Zudem konnten enge Assoziationen zwischen S1 und ersten Schmerz und ACC und zweiten Schmerz gezeigt werden. Diese Befunde belegen, wie in den letzten Jahren differenzierte Einblicke in die Entstehung von Schmerz im menschlichen Kortex gewonnen werden konnten.

Summary

Contrary to the traditional view that the cerebral cortex is not involved in pain perception an extensive cortical network associated with pain processing has been revealed during the past decades. This network consistently includes the primary (S1) and secondary somatosensory cortices (S2), the insular cortex, and the anterior cingulate cortex (ACC). These cortical areas are organized in parallel and contribute to different dimensions of pain experience. The S1 cortex is mainly involved in discriminative aspects of pain, while the S2 cortex seems to have an important role in cognitive aspects of pain perception. The insula has been proposed to be involved in autonomic reactions to noxious stimuli and in pain-related learning and memory. The ACC is closely related to pain affect and may subserve the integration of general affect, cognition, and response selection. Furthermore, first pain appears to be particularly related to activation of S1 whereas second pain is closely related to ACC activation.

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  1. Neurologische Klinik, Heinrich-Heine-Universität, Düsseldorf

    M. Ploner & A. Schnitzler

  2. Neurologische Klinik, Heinrich-Heine-Universität, Moorenstraße 5, 40225, Düsseldorf

    M. Ploner

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  1. M. Ploner
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  2. A. Schnitzler
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Correspondence to M. Ploner.

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Die Arbeit der Autoren wurde unterstützt von der DFG, der Volkswagen-Stiftung und der Ute-Huneke-Stiftung.

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Ploner, M., Schnitzler, A. Kortikale Repräsentation von Schmerz. Nervenarzt 75, 962–969 (2004). https://doi.org/10.1007/s00115-004-1739-y

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