Neuromodulatory treatments for chronic pain: efficacy and mechanisms.
Neuromodulatory treatments for chronic pain: efficacy and mechanisms.
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DOI：
10.1038/nrneurol.2014.12
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发表时间：
2014-03
期刊：
影响因子：
--
通讯作者：
Miró J
中科院分区：
文献类型：
--
作者：
Jensen MP;Day MA;Miró J
慢性疼痛很常见，现有的治疗方法不能为大多数患者提供足够的缓解。神经调节干预，修改大脑过程的基础上的经验，疼痛有可能提供实质性的缓解，为这些患者。本综述的目的是总结关于慢性疼痛的非侵入性神经调节治疗的疗效和机制的知识状态。这些发现为催眠的有效性和积极的副作用提供了支持，并为冥想训练，非侵入性电刺激程序和神经反馈程序的潜在有效性提供了有限的证据。机制研究表明，催眠影响参与疼痛体验的多个神经生理过程。证据还表明，正念冥想对涉及注意力、情绪反应和疼痛的皮层结构和活动有直接和长期的影响。对其他神经调节治疗的机制知之甚少。在本综述中讨论的数据的基础上，使用自我催眠的训练可能被认为是治疗慢性疼痛的可行的“一线”方法。在推荐这些治疗方法用于治疗慢性疼痛之前，需要对冥想训练、无创脑刺激和神经反馈的益处和成本进行更明确的研究。
Chronic pain is common, and the available treatments do not provide adequate relief for most patients. Neuromodulatory interventions that modify brain processes underlying the experience of pain have the potential to provide substantial relief for some of these patients. The purpose of this Review is to summarize the state of knowledge regarding the efficacy and mechanisms of noninvasive neuromodulatory treatments for chronic pain. The findings provide support for the efficacy and positive side-effect profile of hypnosis, and limited evidence for the potential efficacy of meditation training, noninvasive electrical stimulation procedures, and neurofeedback procedures. Mechanisms research indicates that hypnosis influences multiple neurophysiological processes involved in the experience of pain. Evidence also indicates that mindfulness meditation has both immediate and long-term effects on cortical structures and activity involved in attention, emotional responding and pain. Less is known about the mechanisms of other neuromodulatory treatments. On the basis of the data discussed in this Review, training in the use of self-hypnosis might be considered a viable ‘first-line’ approach to treat chronic pain. More-definitive research regarding the benefits and costs of meditation training, noninvasive brain stimulation and neurofeedback is needed before these treatments can be recommended for the treatment of chronic pain.
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