Zusammenfassung
Interozeptive viszerale Schmerzreize werden im Vergleich zu exterozeptiven kutanen thermischen Schmerzreizen von gesunden Frauen als stärker angstauslösend und unangenehmer bewertet, selbst wenn die Reize hinsichtlich der wahrgenommenen Schmerzintensität angepasst sind. Beide Schmerzreize induzieren eine vergleichbare Aktivierung in Hirnarealen sensorisch-diskriminativer Schmerzverarbeitung. Für viszerale Schmerzreize zeigt sich jedoch auch eine stärkere Aktivierung in Hirnarealen, die mit Salienzverarbeitung und absteigender Schmerzhemmung assoziiert sind, selbst wenn die Ergebnisse für intraindividuelle Bewertungsunterschiede in der Schmerzintensität kontrolliert werden. Insbesondere schmerzinduzierte Angst spielt für die Bewertung viszeraler Schmerzen eine entscheidende Rolle.
Abstract
Interoceptive visceral pain is perceived as more fear-inducing and unpleasant compared to cutaneous heat pain in healthy women even when stimuli are matched for perceived pain intensity. On a neural level, both pain stimuli induce comparable neural activation in areas related to processing of sensory-discriminative pain aspects. However, enhanced neural responses are observed in areas associated with salience processing and descending pain inhibition for the visceral pain modality, even when results are controlled for intra-individual differences in perceived pain intensity. Moreover, immanent fear of pain is suggested to play a distinctive role in perception of visceral pain.
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Notes
Interessant ist nebenbei, dass das Reizdarmsyndrom, welches in der Fachliteratur als viszerales chronisches Schmerzsyndrom beschrieben ist, darunter nicht gefasst wird, sondern unter dem Punkt „somatoforme autonome Funktionsstörungen“ (F45.3).
Literatur
Arendt-Nielsen L, Laursen RJ, Drewes AM (2000) Referred pain as an indicator for neural plasticity. Prog Brain Res 129:343–356
Aziz Q, Thompson DG, Ng VW et al (2000) Cortical processing of human somatic and visceral sensation. J Neurosci 20:2657–2663
Cervero F (2009) Visceral versus somatic pain: similarities and differences. Dig Dis 27(Suppl 1):3–10
Dunckley P, Wise RG, Aziz Q et al (2005) Cortical processing of visceral and somatic stimulation: differentiating pain intensity from unpleasantness. Neuroscience 133:533–542
Dunckley P, Wise RG, Fairhurst M et al (2005) A comparison of visceral and somatic pain processing in the human brainstem using functional magnetic resonance imaging. J Neurosci 25:7333–7341
Elsenbruch S, Hauser W, Janig W (2015) Visceral pain. Schmerz 29:496–502
Friston KJ, Holmes AP, Price CJ et al (1999) Multisubject fMRI studies and conjunction analyses. Neuroimage 10:385–396
Fruhstorfer H, Lindblom U, Schmidt WC (1976) Method for quantitative estimation of thermal thresholds in patients. J Neurol Neurosurg Psychiatr 39:1071–1075
Gebhart GF (2000) Pathobiology of visceral pain: molecular mechanisms and therapeutic implications IV. Visceral afferent contributions to the pathobiology of visceral pain. Am J Physiol Gastrointest Liver Physiol 278:G834–G838
George SZ, Dannecker EA, Robinson ME (2006) Fear of pain, not pain catastrophizing, predicts acute pain intensity, but neither factor predicts tolerance or blood pressure reactivity: An experimental investigation in pain-free individuals. Eur J Pain 10:457–465
Hauser W, Grandt D (2002) Psychophysiology of visceral pain syndromes. Schmerz 16:460–466
Hobday DI, Aziz Q, Thacker N et al (2001) A study of the cortical processing of ano-rectal sensation using functional MRI. Brain 124:361–368
Icenhour A, Labrenz F, Ritter C et al (2017) Learning by experience? Visceral pain-related neural and behavioral responses in a classical conditioning paradigm. Neurogastroenterol Motil. https://doi.org/10.1111/nmo.13026
Koenen LR, Icenhour A, Forkmann K et al (2017) Greater fear of visceral pain contributes to differences between visceral and somatic pain in healthy women. Pain 158(8):1599–1608
Labrenz F, Icenhour A, Benson S et al (2015) Contingency awareness shapes acquisition and extinction of emotional responses in a conditioning model of pain-related fear. Front Behav Neurosci 9:318
Mayer EA, Gupta A, Kilpatrick LA et al (2015) Imaging brain mechanisms in chronic visceral pain. Pain 156(Suppl 1):S50–S63
Mertz H, Naliboff B, Munakata J et al (1995) Altered rectal perception is a biological marker of patients with irritable bowel syndrome. Gastroenterology 109:40–52
Meulders A, Vlaeyen JW (2012) Reduction of fear of movement-related pain and pain-related anxiety: an associative learning approach using a voluntary movement paradigm. Pain 153:1504–1513
Nilges P, Rief W (2010) F45.41: chronic pain disorder with somatic and psychological factors: a coding aid. Schmerz 24:209–212
Ptak R (2012) The frontoparietal attention network of the human brain: action, saliency, and a priority map of the environment. Neuroscientist 18:502–515
Schmidt K, Schunke O, Forkmann K et al (2015) Enhanced short-term sensitization of facial compared with limb heat pain. J Pain 16:781–790
Seeley WW, Menon V, Schatzberg AF et al (2007) Dissociable intrinsic connectivity networks for salience processing and executive control. J Neurosci 27:2349–2356
Sommer C, Hauser W, Burgmer M et al (2012) Etiology and pathophysiology of fibromyalgia syndrome. Schmerz 26:259–267
Vlaeyen JW, Linton SJ (2012) Fear-avoidance model of chronic musculoskeletal pain: 12 years on. Pain 153:1144–1147
Wiech K (2016) Deconstructing the sensation of pain: the influence of cognitive processes on pain perception. Science 354:584–587
Wiech K, Lin CS, Brodersen KH et al (2010) Anterior insula integrates information about salience into perceptual decisions about pain. J Neurosci 30:16324–16331
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L.R. Koenen und S. Elsenbruch geben an, dass kein Interessenkonflikt besteht.
Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.
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Koenen, L.R., Elsenbruch, S. Schmerz ist modalitätsspezifisch. Schmerz 32, 139–143 (2018). https://doi.org/10.1007/s00482-018-0281-y
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DOI: https://doi.org/10.1007/s00482-018-0281-y
Schlüsselwörter
- Viszerale Schmerzreize
- Kutane thermische Schmerzreize
- Funktionale Magnetresonanztomographie (fMRT)
- Schmerzinduzierte Angst