Modulation of vagal tone enhances gastroduodenal motility and reduces somatic pain sensitivity
Modulation of vagal tone enhances gastroduodenal motility and reduces somatic pain sensitivity
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DOI：
10.1111/nmo.12760
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发表时间：
2016-04-01
影响因子：
3.5
通讯作者：
Drewes, A. M.
中科院分区：
文献类型：
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作者：
Frokjaer, J. B.;Bergmann, S.;Drewes, A. M.
以迷走神经为主要神经底物的副交感神经系统具有重要的抗感觉作用并影响胃肠道感觉运动功能。我们的研究问题是，分别使用经皮迷走神经电刺激（t-VNS）和深缓呼吸（DSB）对迷走神经张力进行电和生理联合调节，是否可以增加健康受试者的肌肉骨骼疼痛阈值并增强胃十二指肠运动。方法将18名健康受试者随机分为受试者盲法、假对照、交叉试验，采用刺激迷走神经耳支、全吸气量呼吸和强制全呼气的积极方案。记录心脏衍生参数，包括心脏迷走神经张力、肌肉的中度疼痛阈值、骨压力测量、使用冷压试验和液体膳食超声胃十二指肠运动试验的条理性疼痛调节。与假手术相比，t-VNS和DSB积极治疗时心脏迷走神经张力增加（p = 0.009）。与假手术相比，积极治疗组骨痛阈值增加（p = 0.001），胃窦收缩频率增加（p = 0.004），胃十二指肠运动指数增加（p = 0.016）。然而，对肌肉疼痛阈值和条件疼痛调节没有影响。结论和推断本实验研究表明，这种无创性方法结合电和生理调节迷走神经张力，可增强胃十二指肠运动，降低躯体疼痛敏感性。这些发现值得进一步研究以慢性疼痛和胃肠运动障碍为特征的疾病，如功能性消化不良和肠易激综合征。
Background The parasympathetic nervous system, whose main neural substrate is the vagus nerve, exerts a fundamental antinociceptive role and influences gastrointestinal sensori-motor function. Our research question was to whether combined electrical and physiological modulation of vagal tone, using transcutaneous electrical vagal nerve stimulation (t-VNS) and deep slow breathing (DSB) respectively, could increase musculoskeletal pain thresholds and enhance gastroduodenal motility in healthy subjects. Methods Eighteen healthy subjects were randomized to a subject-blinded, sham-controlled, cross-over study with an active protocol including stimulation of auricular branch of the vagus nerve, and breathing at full inspiratory capacity and forced full expiration. Recording of cardiac derived parameters including cardiac vagal tone, moderate pain thresholds to muscle, and bone pressure algometry, conditioned pain modulation using a cold pressor test and a liquid meal ultrasonographic gastroduodenal motility test were performed. Key Results Cardiac vagal tone increased during active treatment with t-VNS and DSB compared to sham (p = 0.009). In comparison to sham, thresholds to bone pain increased (p = 0.001), frequency of antral contractions increased (p = 0.004) and gastroduodenal motility index increased (p = 0.016) with active treatment. However, no effect on muscle pain thresholds and conditioned pain modulation was seen. Conclusions & Inferences This experimental study suggests that this noninvasive approach with combined electrical and physiological modulation of vagal tone enhances gastroduodenal motility and reduces somatic pain sensitivity. These findings warrant further investigation in patients with disorders characterized with chronic pain and gastrointestinal dysmotility such as functional dyspepsia and irritable bowel syndrome.