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통증처리에 있어 대뇌피질의 역할: 기능성 영상 연구를 중심으로

Role of Cerebral Cortex on Pain Processing: From the Evidence of Functional Imaging Studies

이승재|곽경화
대한생물치료정신의학회 (Korean Society Of Biological Therapies In Psychiatry)|2012.04|생물치료정신의학 (Journal of the Korean Society of Biological Therapies in Psychiatry)|제18권 제1호|pp. 25-34|DOI http://dx.doi.org/

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키워드

fMRI통증조절통증처리중추기전뇌자기공명영상통증의 공감Pain processingcentral mechanismpain modulationempathy for pain
주제분류정신과학

초록

통증은 감각적, 정서적, 인지적 요소들간의 상호작용이라는 점에서 다른 감각들과는 차별화된다. 최근 뇌영상술의 발전으로 이러한 상호작용에 있어서의 대뇌피질의 역할이 밝혀지고 있다. 일차 및 이차체성감각피질로 대표되는 외측통증체계(lateral pain system)는 통증의 강도와 위치를 파악하는 감각-식별 영역(sensory-discriminative domain)을 담당하는 반면 내측통증체계(medical pain sy-stem)는 변연계를 통한 정서적 반응과 관련하여 통증처리에 있어 정서-동기 영역(affective-motivational domain)을 담당한다. 두 가치 체계의 상호작용을 통해 우리는 통증을 경험하게 되며, 이는 예측, 기대, 다른 인지적 요소와 관련된 뇌기전에 의해 하향식 조정(top-down modu-lation)을 받게 된다.

Abstract

Functional imaging techniques have allowed researchers to look within the brain, and revealed the cortical representation of pain. Initial experiments, performed in the early 1990s, revolutionized pain research, as they demonstrated that pain was not processed in a single cortical area, but in several distributed brain regions. To date, neuroscientific research on pain processing points out a distinction between the sensory-discriminative and the affective-motivational domains. The former domain engages stimulus localization and intensity and is assessed with ratings of intensity while the latter one involves the affective component of pain and is measured with ratings of unpleasantness. This duality is also framed in terms of medial and lateral pain system based on thalamic afferents. These two dimensions of pain processing are underpinned by discrete yet interacting neural networks. In this brief article, we reviewed the imaging literature to date that has allowed these advances to be made, and aimed to take these new insights into the clinic, to investigate and provide new remedies for chronic pain sufferers.

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