Left vagus nerve stimulation suppresses experimentally induced pain
Left vagus nerve stimulation suppresses experimentally induced pain
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DOI：
10.1212/wnl.55.8.1167
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发表时间：
2000-10-24
期刊：
影响因子：
9.9
通讯作者：
Handwerker, HO
中科院分区：
文献类型：
--
作者：
Kirchner, A;Birklein, F;Handwerker, HO
目的：探讨电刺激迷走神经是否对人体有抗伤害感受作用。背景：在各种动物研究中，迷走神经刺激被证明可以抑制伤害性行为以及脊髓伤害性神经元的电反应。在人类中，慢性左迷走神经刺激用于治疗药理学上难治性癫痫。方法：对10例迷走神经刺激器植入前和植入后两次发作的实验性疼痛患者，采用不同的控制刺激，包括毒辣、强压和短冲击。疼痛以视觉模拟量表量化。12名年龄和性别匹配的非癫痫患者作为对照。结果：迷走神经刺激减少了与连续5次刺激间隔1.5秒相关的疼痛增加（“上弦”；p < 0.001）。同样，迷走神经刺激可减轻紧张性压力疼痛（p < 0.03）。与单冲击刺激相关的疼痛以及热痛阈值在迷走神经刺激下没有改变。因此，迷走神经刺激导致疼痛缓解主要在实验过程中，疼痛强度被中央加工放大。抗伤害感受作用与迷走神经刺激的急性开关周期无关。结论：迷走神经刺激能有效减轻人体疼痛。在人类中，抗痛觉作用可能依赖于中枢抑制而不是外周痛觉机制的改变。这些结果表明迷走神经刺激在疼痛治疗中的潜在作用。
Objective: To test whether electric stimulation of the vagus nerve has an antinociceptive effect in humans. Background: In a variety of animal studies, vagus nerve stimulation was shown to inhibit nociceptive behavior as well as electric responses of spinal nociceptive neurons. In humans, chronic left vagus nerve stimulation is used to treat pharmacologically refractory epilepsy. Methods: The authors investigated experimental pain in 10 patients with seizures before and twice after implantation of a vagus nerve stimulator by using different controlled stimuli, including noxious heat, tonic pressure, and short impact. Pain was quantified on a visual analogue scale. Twelve nonepileptic age- and gender-matched individuals served as control subjects. Results: Vagus nerve stimulation reduced increasing pain associated with trains of five consecutive stimuli at 1.5-second intervals ("wind-up"; p < 0.001). In a similar manner, pain on tonic pressure was reduced by vagus nerve stimulation (p < 0.03). Pain associated with single-impact stimuli as well as heat pain thresholds were unaltered under vagus nerve stimulation. Thus, vagus nerve stimulation led to pain relief predominantly in experimental procedures in which pain magnitude was amplified by central processing. The antinociceptive effect was independent of the acute on-off cycles of vagus nerve stimulation. Conclusions: Vagus nerve stimulation is effective in reducing pain in humans. In humans, the antinociceptive effect might rely on central inhibition rather than alterations of peripheral nociceptive mechanisms. These results indicate a promising, potential future role of vagus nerve stimulation in pain treatment.