Neuro-imagerie du système opio?de encéphalique chez l’Homme

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• 作者：J. Maarrawi (1) (2)
  L. Garcia-Larrea (2)
  
• 关键词：Douleurs neuropathiques ; Douleurs nociceptives ; Système opio?de endogène ; Tomographie par émission de positons ; Stimulation du cortex moteur ; Neuropathic pain ; Nociceptive pain ; Endogenous opioid system ; Positron emission Tomography ; Motor cortex stimulation
• 刊名：Douleur et Analg篓娄sie
• 出版年：2014
• 出版时间：March 2014
• 年：2014
• 卷：27
• 期：1
• 页码：19-31
• 全文大小：481 KB
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• 作者单位：J. Maarrawi (1) (2)
  L. Garcia-Larrea (2)
  
  1. Laboratoire de neurosciences, Faculté de médecine, Université St-Joseph, Beyrouth, Liban
  2. Centre de recherche en neurosciences de Lyon, équipe Neuropain, INSERM U1028, Lyon, France
  
• ISSN：1951-6398

文摘

The existence of opioid receptors (OR) has been suspected for a long time, but their demonstration in nervous tissue and the discovery of their natural ligands were realized in the 1970’s. By 1985, the study of brain OR was possible in vivo using Positron Emission Tomography (PET). Since then, multiple PET studies contributed to clarify the physiology and pathology of human endogenous opioid system in several conditions and pathologies. Thus, activation studies in tonic experimental pain have demonstrated opioid system activation in the amygdala ipsilateral to the painful stimuli and in the medial and lateral thalamus, insular cortex and hypothalamus, and finally in the anterior cingulate gyrus and prefrontal cortex bilaterally. This activation was negatively correlated with the intensity of pain perception. These activation studies have also demonstrated a sex-dependent differential activation in the magnitude and direction of the endogenous opioid system. Concerning nociceptive pain, endogenous opioid secretion is very likely to occur as a reaction to pain, since PET studies have demonstrated a decrease in the binding of the exogenous ligand to OR in patients suffering of pain secondary to chronic inflammatory conditions like rheumatoid arthritis. Concerning neuropathic pain (NP), endogenous opioid secretion is also very likely to occur as a reaction to pain. Furthermore, brain opioid receptors are relatively spared in peripheral NP, while a loss of OR lateralized to the hemisphere containing the causal lesion of pain (contralateral to clinical pain) is most likely to occur in central NP, within the medial nociceptive pathways. This difference in OR distribution between the peripheral and central types of NP could explain their differential response to exogenous opioids which give better response in the peripheral type. Analgesic Motor Cortex Stimulation (MCS), indicated in severe refractory NP, induces endogenous opioid secretion in key areas of the endogenous opioid system, which may explain one of the mechanisms of action of this procedure. A preoperative diprenorphine PET scan may predict the potency of motor cortex stimulation to relive neuropathic pain. All these studies incite to the development of future investigations in order to clarify the role of the opioid system in various disorders of the nervous system.