Identifying and Engaging Neuronal Oscillations by Transcranial Alternating Current Stimulation in Patients With Chronic Low Back Pain: A Randomized, Crossover, Double-Blind, Sham-Controlled Pilot Study.
Identifying and Engaging Neuronal Oscillations by Transcranial Alternating Current Stimulation in Patients With Chronic Low Back Pain: A Randomized, Crossover, Double-Blind, Sham-Controlled Pilot Study.
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DOI：
10.1016/j.jpain.2018.09.004
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发表时间：
2019-03
期刊：
影响因子：
--
通讯作者：
Fröhlich F
中科院分区：
文献类型：
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作者：
Ahn S;Prim JH;Alexander ML;McCulloch KL;Fröhlich F
慢性疼痛与中枢神经系统的适应不良重组有关。最近的研究表明，大规模的脑电活动模式，如丘脑-皮层系统中的神经元网络振荡的紊乱在慢性疼痛的病理生理学中起着关键作用。然而，关于这种网络病理是否以及如何可以用非侵入性脑刺激作为非药物治疗选择来靶向，人们知之甚少。我们假设，α振荡，在人类大脑中的一个突出的丘脑-皮层活动模式，在慢性疼痛受损，可以调制经颅交流电刺激（tACS）。我们在慢性下腰痛（CLBP）患者中进行了一项随机、交叉、双盲、假对照研究，以研究α振荡与疼痛症状之间的关系，以确定靶点，以及tACS是否可以参与该靶点，从而缓解疼痛。我们使用高密度脑电图来测量α振荡，发现刺激前躯体感觉区基线的振荡强度与疼痛症状呈负相关。与假（安慰剂）刺激相比，用α-tACS刺激显著增强了体感区的α振荡。刺激引起的增加α振荡的躯体感觉区与疼痛缓解。鉴于这些成功的靶点识别和参与的发现，我们建议用tACS调节α振荡可能代表CLBP的靶向特异性非药物治疗方法。本试验已在ClinicalTrials.gov（NCT 03243084）中注册。这项研究表明，经颅交流电刺激的合理设计，即目标识别，参与和验证，可能是慢性腰痛患者的非药物治疗方法。
Chronic pain is associated with maladaptive reorganization of the central nervous system. Recent studies have suggested that disorganization of large-scale electrical brain activity patterns such as neuronal network oscillations in the thalamo-cortical system plays a key role in the pathophysiology of chronic pain. Yet, little is known about if and how such network pathologies can be targeted with non-invasive brain stimulation as a non-pharmacological treatment option. We hypothesized that alpha oscillations, a prominent thalamo-cortical activity pattern in the human brain, are impaired in chronic pain and can be modulated with transcranial alternating current stimulation (tACS). We performed a randomized, crossover, double-blind, sham-controlled study in patients with chronic low back pain (CLBP) to investigate how alpha oscillations relate to pain symptoms for target identification and if tACS can engage this target and thereby induce pain relief. We used high-density electroencephalography to measure alpha oscillations and found that the oscillation strength in the somatosensory region at baseline before stimulation was negatively correlated with pain symptoms. Stimulation with alpha-tACS compared to sham (placebo) stimulation significantly enhanced alpha oscillations in the somatosensory region. The stimulation-induced increase of alpha oscillations in the somatosensory region was correlated with pain relief. Given these findings of successful target identification and engagement, we propose that modulating alpha oscillations with tACS may represent a target-specific, non-pharmacological treatment approach for CLBP. This trial has been registered in ClinicalTrials.gov (NCT03243084). This study suggests that a rational design of transcranial alternating current stimulation, which is target identification, engagement, and validation, could be a non-pharmacological treatment approach for patients with chronic low back pain.