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Chronischer Schmerz verändert die Struktur des Gehirns

Chronic pain alters the structure of the brain

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Zusammenfassung

Obwohl chronische Schmerzen und die Chronifizierung von Schmerz zu den häufigsten Herausforderungen einer Schmerzambulanz gehören, ist die Pathogenese chronischer Schmerzen weiterhin unklar. Neuere Ergebnisse zeigen hirnmorphologische Veränderungen bei Patienten mit chronischen Schmerzen im Sinne einer regional spezifischen Abnahme an grauer Substanz. Diese Veränderungen sind unabhängig vom Syndrom oder der anatomischen Projektion der Schmerzen und überlappen im vorderen und mittleren Cingulum, der vorderen Inselrinde, dem orbitofrontalen Kortex und dem Hirnstamm. Die Interpretation der Abnahme an grauer Substanz wird in der Literatur fälschlicherweise meist als Schädigung oder Atrophie des Gehirns interpretiert. Die funktionelle Relevanz dieser Hirnveränderung ist noch nicht klar, jedoch ist die Übereinstimmung der bisher publizierten Befunde verblüffend und deutet darauf hin, dass das sog. Schmerzgedächtnis visualisiert werden kann.

Abstract

Local morphologic alterations of the brain in areas ascribable to the transmission of pain were recently detected in patients suffering from phantom pain, chronic back pain, irritable bowl syndrome, fibromyalgia and frequent headaches. These alterations were different for each pain syndrome, but overlapped in the cingulate cortex, the orbit frontal cortex, the insula and dorsal pons. As it seems that chronic pain patients have a common “brain signature” in areas known to be involved in pain regulation, the question arises whether these changes are the cause or the consequence of chronic pain. The in vivo demonstration of a loss of brain gray matter in patients suffering from chronic pain compared to age and sex-matched healthy controls could represent the heavily discussed neuroanatomical substrate for pain memory.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Diese Studie wurde von der DFG (MA 1862/2-3) und vom Deutschen Zentrum für Luft- und Raumfahrt (DLR) des Bundesministeriums für Bildung und Forschung (BMBF) (Förderkennzeichen: 01EM0517) gefördert.

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  1. Institut für Systemische Neurowissenschaften, Universitäts-Krankenhaus Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland

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May, A. Chronischer Schmerz verändert die Struktur des Gehirns. Schmerz 23, 569–575 (2009). https://doi.org/10.1007/s00482-009-0842-1

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  • DOI: https://doi.org/10.1007/s00482-009-0842-1

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