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1 AUTHOR:
Dragos Cirneci
Spiru Haret University, Bucharest
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Evolutia creierului
prin encefalizare sau de ce
schimbarea e dureroasa
~
Dr. Drago~Grneci
Syner<jlN1
Abstract
Rezumat
Aversive learning seems to be mediated by the neural systems responsive to pain, while the subjedive perception of
pain was found to be implemented by the same cerebral
network involved in orienting attention to novel, unexpeded stimuli, and also in errors detedion. This"attentional net-
fnvajarea
aversiva este realizata
in creier de sistemele
neuronale ce raspund la durere, iar percepjia subiectiva a
durerii este realizara de aceea~i rejea cerebrala implicata
in orientarea
involuntara
a atenjiei ca raspuns la ceva
nou, nea~teptat,
dar ~i in procesarea
erorilor. Sistemul
"atenjional"
care reorienteaza
atenjia
ca raspuns la
stimuli
nea~teptaji
sau foarte relevanji
- "reflexul
de
orientare"
- este suprapus peste cel de depistare a peri~i de declan~area starii
colelor, iar la om este raspunzator
anxioase. Biochimic,
componenta
fazica a dopaminei
~i
noradrenalinei
este implicata
in procesarea
schimbarii
~i com uta rea atenjiei in vederea adaptarii la schimbare,
~i
ins a componenta
fazica a dopaminei
este implicata
in adaptarea
la durere sau raspunsul analgezic, facand
astfelo
legatura biochimica
intre durere ~i raspunsulla
schimbare.
Mai mult, acelea~i rejele a creierului
implicate in procesarea
noului ~i percepjia durerii sunt implicate ~i in procesarea
feedback-ului
negativ ~i a respingerii sociale, iar aceste procesari declan~eaza
la randul
lor un raspuns imunitar
de tip proinflamator,
sugerand
ca raspunsul imunitar,
care este modulat de relajiile noastre socia Ie, precum ~i de reu~ita in acjiune ~i capacitatea de adaptare la schimbari in mediu.
Cuvinte-cheie:
orientarea atenjiei, durere, procesare feedback, raspuns imunitar
(Of15ulting
work" managing automatic shifting of attention to unexpeded, relevant stimuli - 'orienting reflex" - is superimposed
over the danger detection mechamisms, and is known to
be involved in triggering anxiety in humans. Biochemically,
phasic dopaminergic and noradrenergic components are
responsible for processing novelty and triggering attention
shiftings in response to environmental changes, phasic dopamine component being involved also in adaptation to
pain - or analgesic response - making a "chemical connection" between pain processing and the mechanisms which
trigger behavioral adaptation to change. In addition, the
same brain network which gestionates novelty detedion
and physical pain subjective perception are involved in processingof negative feedback and social rejedion, theseprocessesbeing associated with a proinflammatory immune
response,suggesting that immune response is modulated
by social relationships and the successin activity or our ability to adapt to change.
Keywords: attention orienting, pain, feedback processing, immune response
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fica rea stimulilor durero~i, ci in aspectele evaluarii subiective ale stimulilor durero~i (Kringelbach, 2005; Vogt, 2005;
Amodio ~i Frith, 2006). Aceste proieqii ajung in special in
zona dorsala a cingulatului anterior (girusul cingulat), dar
~i in zona rostrala. Neuronii din cele doua zone au rol diferit: cei din zona rostrala semnalizeaza caracterul de neplacut al unui stimul, in timp ce zona dorsala este implicata in
declan~area comportamentului
de evitare (partea caudala) ~i a reaqiei de frica (partea dorsala) (Vogt, 2005).
Re~eaua durerii con~ine divizii somato-senzoriale, emo~ionale, aten~ionale ~i motorii (Berns ~i cola b., 2006). A~teptarile pe care Ie avem privind durerea sau efectul analgezic al unui medicament inf1uen~eaza in mod direct
felul cum experimentam ulterior 0 stimulare dureroasa.
Daca activitatea in re~eaua durerii - formata din cingulatul
anterior pregenual ~i cortexul insular anterior - este ridicata inaintea stimularii dureroase, omul este intr-o stare
de receptivitate fa~a de durere ~i percepe stimulul ca fiind mai intens (Boly ~i cola b., 2007). Sesizarea stimulului
dureros este data de zona mediana anterioara/cingulat
anterior rostral (BA 32) in timp ce evaluarea durerii este
localizata mai ventral ~i posterior (BA 24) (Boly ~i colab.,
2007). Direqionarea aten~iei inf1uen~eaza activitatea insulei anterioare - 0 zona care prime~te inputuri nociceptive ~i este implicata in evaluarea intensita~ii subiective a
durerii -, activitatea insulara crescand atunci cand aten~ia
este orientata catre durere. Com uta rea voluntara a aten~iei se realizeaza de cortexul parietal posterior (aria 7)
cu extensie catre sulcusul postcentral (aria 5) ~i campul
frontal ocular (aria 8) sau a~a-numita re~ea aten~ionala
dorsala, care se ocupa atat cu com uta rea aten~iei, cat ~i
cu men~inerea acesteia in detrimentul stimulilor distractori. De asemenea, s-a constatat 0 reducere a activita~ii in
talamusul median, cingulatul anterior (BA 24) ~i cortexul
somatosenzorial secundar 0 data cu diminuarea durerii,
reducere mediata de zona frontala inferioara - BA 45 ~i 47
- ~i zona periapeductului cenu~iu (pAG). Zona 45-47, dar
~i PAG sunt parte din re~eaua aten~ionala ventrala (sau
cingulo-operculara)
specializata in detectarea stimulilor
cu relevan~a comportamentala,
in special daca sunt noi,
inten~i, nea~tepta~i sau poten~ial periculo~i ~i declan~eaza 0 stare de alerta. Durerea se pare ca activeaza aceasta
re~ea, iar starea afectiva negativa care implica re~eaua PAG
- amigdala - cortex insular anterior - cortex cingulat - orbitofrontallateral
(BA 45, 47) accentueaza percep~ia durerii,
afectand capacitatea acestor zone de a modula senza~ia
dureroasa (Villemure ~i Schweinhardt, 2010).
Concluzionand,
percep~ia subiectiva a durerii este
realizata de aceea~i re~ea cerebrala implicata in orientarea
involuntara a aten~iei ca raspuns la ceva nou, nea~teptat.
interferente
stan,a de amigdala bazolaterala (Davis ?i Whalen, 2001).
Ea este legata prin proieqii glutamatergice de capsula nucleului accumbens, iar expunerea la stimuli noi cre?te dopamina in nucleul accumbens, fenomen mai accentuat la
persoanele anxioase sau la cele care au stat multa vreme
izolate. Efectul este de a se declan?a 0 motiva,ie de evitare adica baza inhibi,iei comportamentale
(Barrot ?i colab.,
2005). Consecutiv amigdalei, procesarea are loc in hipocamp in girusul dentat?i zona CA3, apoi de zona intraparieta la, iar apoi de cortexullateral prefrontal ?i este mediata
noradrenergic (Buschman ?i Miller, 2007; Hirsh ?i Inzlicht,
2008; Sara, 2009). Studiile folosind RMN funqional au aratat ca in depistarea unui stimul nou sunt implicate: nucleii
pulvinari talamici, coliculul superior mezencefalic, girusul
frontal superior (BA 8), girusul frontal mijlociu (BA 10, 9,
46), cingulatul anterior (BA 32), girusul frontal inferior (BA
45) ?i zona intraparietala ventrala (aria 40). incluzfmd jonc,iunea temporoparietala
(aria 39) (Hopfinger, Buonocore
?i Mangun, 2000; Yantis ?i colab., 2002; Pessoa ?i Ungerleider, 2004; Shomstein ?i Behrmann, 2005). Activitatea in
orbitofrontalullateral
caudal, la grani,a cu ventrolateralul
prefrontal (BA 45) este rela,ionata cu detectarea oricarui
eveniment nea?teptat/improbabil
(Parris ?i cola b., 2007).
Tntotdeauna cand ne intalnim cu un stimul nou, zona orbitofrontala dreapta (BA 45) se activeaza pentru a encoda
acest stimul, legandu-I de contextul apari,iei (Frey?i Petrides, 2000).
Deci, re,eaua de procesare subiectiva a durerii este aceea?i care raspunde la nou, dar ?i la peri co I, formand baza
neuronala a inva,arii aversive, precum ?i a anxieta,ii.
Du~ere'.Pr~cesarea gre~elilor~iini!ierea
schlmbaru
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psihiatru
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RasRunsul biochimic
la schimbare ~i calmarea durerii
Intensitatea efectului placebo asupra unui individ se
~tie ca este legata de cantitatea de dopamina eliberata in
nucleul accumbens, iar oamenii care sunt mai responsivi
la placebo sunt cei care se a~teapta in mai mare masura sa
ca~tige intr-un joc de tip Gambling. Efectul placebo este
cu atat mai puternic cu cat este mai mare activarea receptorilor D2/D3 dopaminergici din accumbens in faza de anticipare a ca~tigului, iar oamenii care prezinta 0 activitate
sinaptica mai ridicata in accumbens in timpul a~teptarii
unei recompense ~i simt un arousal pozitiv mai accentuat,
interferente
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aza raspunsul inflamator la stres social. Cele doua structuri sunt conectate cu hipotalamusul ?i trunchiul cerebral
?i fac parte din reteaua visceromotorie care controleaza
raspunsul endocrin ?i vegetativ. Oe?i cele doua sunt parte
?i din reteaua de perceptie a durerii, studiile au implicat
aceste structuri intr-un sistem mai general de stres pe care
11 activeaza orice tip de evenimente
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Oeci, putem concluziona ca detectarea erorilor, a schimbarilor, dar ?i feedback-urile socia Ie negative declan?eaza
activarea aceleia?i retele a creierului implicate in perceptia durerii, iar aceasta activare declan?eaza la randul ei un
raspuns imunitar proinflamator. De aici ?i pana la a spune
ca raspunsul imunitar este modulat de relatii1e noastre
socia Ie, precum ?i de reu?ita in aqiune ?i capacitatea de
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