【原】纤维肌痛症中注意力镇痛作用的中枢疼痛的调节机制（十）

 英语晨读 ·

山东省立医院疼痛科英语晨读已经坚持10余年的时间了，每天交班前15分钟都会精选一篇英文文献进行阅读和翻译。一是可以保持工作后的英语阅读习惯，二是可以学习前沿的疼痛相关知识。我们会将晨读内容与大家分享，助力疼痛学习。

本次文献选自Oliva V, Gregory R, Brooks JCW, Pickering AE. Pain.2022;163(1):125-136. 本次学习由邱凤主治医师主讲。

3.5. Task performance in the functional magnetic resonance imaging experiment

To assess performance on the RSVP task during the fMRI experiment, the subject's button responses were recorded and used to calculate d’. We noted that controls performed the task better overall in the scanner as reflected in the between-subject (ie, group) effect (F(1,38) = 10.2, P = 0.003), indicating that our initial calibration (outside the scanner) did not fully compensate for the differences in performance levels between the groups when they were challenged within the scanner (Fig. 3). Importantly, and as intended, the hard task was more challenging than the easy task with both groups showing a main effect of task (F(1,38) = 46.0, P < 0.0001, mixed ANOVA, Fig. 3). Patients with fibromyalgia and controls showed a similar drop in performance when comparing the easy with hard tasks because there was no interaction between task performance and group (F(1,38) = 2.7, P = 0.11). Further analysis indicated that stimulus temperature had no effect on task performance (main effect of temperature F(1,38) = 0.2, P = 0.63), and there was no interaction between task and temperature (F(1,38) = 0.9, P = 0.34) nor between temperature and group (F(1,38) = 2.6, P = 0.12).

3.5. 功能磁共振成像实验中的任务表现

为了评估fMRI实验期间RSVP任务的表现，我们记录了受试者的按钮反应，并用于计算d'。我们注意到，对照组在扫描仪中执行任务的总体情况较好，这反映在受试者间（即组）效应（F（1,38）=10.2，P=0.003），表明我们最初的校准（在扫描仪外）没有完全补偿各组在扫描仪内的表现水平差异（图3）。重要的是，正如预期的那样，困难任务比简单任务更具挑战性，两组都显示出任务的主效应（F（1,38）=46.0，P<0.0001，混合方差分析，图3）。纤维肌痛患者和对照组在比较简单任务和困难任务时表现出类似的下降，因为任务表现和组别之间没有交互作用（F（1，38）=2.7，P=0.11）。进一步的分析表明，刺激温度对任务表现没有影响（温度的主效应F（1,38）=0.2，P=0.63），任务和温度之间没有交互作用（F（1,38）=0.9，P=0.34），温度和小组之间也没有交互作用（F（1,38）=2.6，P=0.12）。

3.6. Neuroimaging analysis

The behavioural results indicated that the patients with fibromyalgia had thermal hyperalgesia and overall a lower level of performance on the RSVP task, but when these factors were mitigated by adjusting stimulus temperature to percept and task speed to performance (in the prescanner session), they could still produce attentional analgesia. However, it was not clear if they recruited the same brain networks as healthy controls to produce this analgesic effect. Therefore, the same analysis strategy used for the behavioural pain ratings was also applied to the fMRI data. To determine main effects in the patterns of activation in the brain and the brainstem, data from both groups were pooled and subsequently differences between the subject groups were explored.

3.6. 神经影像学分析

行为学结果表明，纤维肌痛患者有痛觉过敏，而且在RSVP任务上的总体表现水平较低，但当通过调整刺激温度与感知、任务速度与表现（在扫描前的环节）来缓解这些因素时，他们仍能产生注意力镇痛作用。然而，尚不清楚他们是否使用了与健康对照组相同的大脑网络来产生这种镇痛效果。因此，用于行为疼痛评级的相同分析策略也被应用于fMRI数据。为了确定大脑和脑干激活模式的主要效应，两组的数据被集中起来，随后探讨了各组之间的差异。