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Mechanismen der endogenen Schmerzmodulation am Beispiel der Placeboanalgesie

Befunde aus der funktionellen Bildgebung

Mechanisms of endogenous pain modulation illustrated by placebo analgesia

Functional imaging findings

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Zusammenfassung

Die zentrale Repräsentation nozizeptiver Information und die damit verbundene Wahrnehmung von Schmerz unterliegen ausgeprägten pro- und antinozizeptiven Modulationen durch kognitive Prozesse. Die Placeboanalgesie ist eines der eindrücklichsten Beispiele der kognitiven Schmerzmodulation und damit das Parade-Paradigma für die Untersuchung der Mechanismen der körpereigenen Schmerzmodulation. Die Zusammenschau verschiedener wichtiger Arbeiten in den vergangenen Jahren bestätigt, dass es sich bei der Placeboanalgesie um eine Form der endogenen, kognitiv vermittelten Schmerzhemmung handelt, die zumindest partiell über die Ausschüttung endogener Opiate vermittelt wird. Mithilfe von modernen funktionell-bildgebenden Techniken konnten die zentralnervösen Korrelate der Placeboanalgesie identifiziert werden. Hierbei scheint zingulofrontalen Hirnarealen wie dem dorsolateralen präfrontalen Kortex und dem rostralen anterioren Zingulum in Kombination mit einem subkortikalen, antinozizeptiven Netzwerk eine Schlüsselrolle zuzukommen. Die verminderte Schmerzempfindung während der Placeboanalgesie geht mit einer verminderten Aktivierung schmerzrelevanter Areale einher. Jüngste Daten der funktionellen Bildgebung des Spinalmarkes weisen darauf hin, dass diese endogen vermittelte Hemmung afferenter nozizeptiver Information bereits auf eine Modulation nozizeptiven Inputs auf Höhe des spinalen Hinterhorns zurückzuführen ist. In diesem Beitrag werden der aktuelle Stand der funktionellen Bildgebung der Mechanismen der kognitiven Schmerzmodulation am Beispiel der Placeboanalgesie dargestellt und Ausblicke für zukünftige Forschungsarbeiten in diesem Gebiet diskutiert.

Abstract

Nociceptive information processing and related pain perception are subject to substantial pro- and antinociceptive modulation. Research on the involved circuitry and the implemented mechanisms is a major focus of contemporary neuroscientific studies in the field of pain and will provide new insights into the prevention and treatment of chronic pain states. Placebo analgesia is a powerful clinical example of the cognitive modulation of pain perception. In placebo analgesia the administration of an inert substance will produce an analgesic effect if the subject is convinced that the substance is a potent analgesic. Recent neuroimaging studies have started to characterize the neural circuitry supporting the placebo analgesic effect. The converging evidence from these studies supports the concept that during placebo analgesia cingulo-frontal regions interact with subcortical structures involved in endogenous antinociception to produce the placebo-induced reduction in pain perception. The subject’s report of reduced pain during placebo analgesia coincides with decreased activity in the classic pain areas. This indicates that the altered pain experience during placebo analgesia results from active inhibition of nociceptive input. This cognitively triggered endogenous modulation of pain involves, at least in part, the endogenous opioid system. Most recently, functional magnetic resonance imaging data of the human spinal cord revealed that these mechanisms involve the inhibition of nociceptive processing at the level of the dorsal horn of the spinal cord. Here we discuss recent advances in pain imaging research focusing on cognitively triggered endogenous pain control mechanisms and respective implications for future research strategies.

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  1. Klinik und Poliklinik für Neurologie, Universitäts-Klinikum Hamburg Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland

    U. Bingel

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Bingel, U. Mechanismen der endogenen Schmerzmodulation am Beispiel der Placeboanalgesie. Schmerz 24, 122–129 (2010). https://doi.org/10.1007/s00482-010-0901-7

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