The effects of transcranial direct current stimulation in patients with neuropathic pain from spinal cord injury
The effects of transcranial direct current stimulation in patients with neuropathic pain from spinal cord injury
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DOI：
10.1016/j.clinph.2014.05.034
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发表时间：
2015-02-01
影响因子：
4.7
通讯作者：
Auvichayapat, Paradee
中科院分区：
文献类型：
--
作者：
Ngernyam, Niran;Jensen, Mark P.;Auvichayapat, Paradee
目的：经颅直流电刺激（tDCS）已被证明可以有效减轻神经性疼痛，但其各自的机制仍然很大程度上未知。当前的研究测试了这样的假设：tDCS 减轻疼痛与 theta-alpha 范围内峰值频谱密度的增加有关。方法：20 名患有脊髓损伤和双侧神经性疼痛的患者在左侧主要运动区 (M1) 接受单次假手术和阳极 tDCS (2 mA) 治疗，持续 20 分钟。治疗顺序是随机分配的。比较不同治疗条件下疼痛强度和脑电图频谱分析峰值频率的术前和术后变化。结果：积极治疗条件（M1 上的阳极 tDCS）而非假治疗导致疼痛强度显着降低。此外，与研究假设一致，相对于假 tDCS 条件下的参与者，在活动 tDCS 条件下的参与者中，通过放置在刺激部位上的电极评估的峰值 theta-alpha 频率 (PTAF) 从训练前到训练后增加更多。此外，我们发现疼痛强度的降低和刺激部位 PTAF 的增加之间存在显着关联。结论：这些发现与左侧 M1 的阳极 tDCS 可能有效的可能性是一致的，至少部分是因为它导致 M1 皮质兴奋性增加，这可能是由于运动皮层刺激的疼痛抑制作用可能影响下行疼痛调节系统。未来的研究需要确定左前活动增加和疼痛减轻之间是否存在因果关系。意义：该结果提供了关于经颅直流电刺激（tDCS）对神经病理性疼痛和大脑振荡变化的影响的新发现。 (C) 2014 年国际临床神经生理学联合会。由爱思唯尔爱尔兰有限公司出版。保留所有权利。
Objective: Transcranial direct current stimulation (tDCS) has demonstrated efficacy for reducing neuropathic pain, but the respective mechanisms remain largely unknown. The current study tested the hypothesis that pain reduction with tDCS is associated with an increase in the peak frequency spectrum density in the theta-alpha range.Methods: Twenty patients with spinal cord injury and bilateral neuropathic pain received single sessions of both sham and anodal tDCS (2 mA) over the left primary motor area (M1) for 20 min. Treatment order was randomly assigned. Pre-to post-procedure changes in pain intensity and peak frequency of electroencephalogram spectral analysis were compared between treatment conditions.Results: The active treatment condition (anodal tDCS over M1) but not sham treatment resulted in significant decreases in pain intensity. In addition, consistent with the study hypothesis, peak theta-alpha frequency (PTAF) assessed from an electrode placed over the site of stimulation increased more from pre-to post-session among participants in the active tDCS condition, relative to those in the sham tDCS condition. Moreover, we found a significant association between a decrease in pain intensity and an increase in PTAF at the stimulation site.Conclusions: The findings are consistent with the possibility that anodal tDCS over the left M1 may be effective, at least in part, because it results in an increase in M1 cortical excitability, perhaps due to a pain inhibitory effect of motor cortex stimulation that may influence the descending pain modulation system. Future research is needed to determine if there is a causal association between increased left anterior activity and pain reduction.Significance: The results provide new findings regarding the effects of tDCS on neuropathic pain and brain oscillation changes. (C) 2014 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.