Immediate and Sustained Effects of 5-Day Transcranial Direct Current Stimulation of the Motor Cortex in Phantom Limb Pain
Immediate and Sustained Effects of 5-Day Transcranial Direct Current Stimulation of the Motor Cortex in Phantom Limb Pain
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DOI：
10.1016/j.jpain.2015.03.013
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发表时间：
2015-07-01
期刊：
影响因子：
4
通讯作者：
Maravita, Angelo
中科院分区：
文献类型：
--
作者：
Bolognini, Nadia;Spandri, Viviana;Maravita, Angelo
本研究探讨了经颅直流电刺激（tDCS）运动皮层对截肢后幻肢痛（PIP）的镇痛作用。8例单侧下肢或上肢截肢和慢性PLP受试者入组交叉、双盲、假手术对照治疗项目。连续5天，以1.5 mA的强度在运动皮层上施加阳极（活性或假）tDCS 15分钟。用活性tDCS（而非假tDCS）进行5天治疗可诱导背景PLP和PLP发作频率持续降低，并在治疗结束后持续1周。此外，在活动tDCS的每一天，患者报告立即PLP缓解，沿着移动幻肢的能力增加。相反，患者对假tDCS的即时反应是可变的，以PLP水平相对于基线的增加或减少为标志。这些结果表明，用tDCS刺激运动皮层5天的治疗可以诱导截肢者PLP的稳定缓解。针对运动皮层的神经调节似乎是一个很有前途的选择，这种衰弱的神经病理性疼痛的条件，这往往是难治的经典药理学和手术treatment.Perspective：这项研究描述了持续和即时的影响，运动皮层刺激tDCS截肢后PLP，其镇痛作用似乎链接到电机激活的幻肢。这些结果有助于开发tDCS作为神经病理性疼痛的治疗工具。(C)2015年美国疼痛协会American Pain Society
The study explored the analgesic effects of transcranial direct current stimulation (tDCS) over the motor cortex on postamputation phantom limb pain (PIP). Eight subjects with unilateral lower or upper limb amputation and chronic PLP were enrolled in a crossover, double-blind, sham-controlled treatment program. For 5 consecutive days, anodal (active or sham) tDCS was applied over the motor cortex for 15 minutes at an intensity of 1.5 mA. The 5-day treatment with active, but not sham, tDCS induced a sustained decrease in background PLP and in the frequency of PLP paroxysms, which lasted for 1 week after the end of treatment. Moreover, on each day of active tDCS, patients reported an immediate PLP relief, along with an increased ability to move their phantom limb. Patients' immediate responses to sham tDCS, on the contrary, were variable, marked by an increase or decrease of PLP levels from baseline. These results show that a 5-day treatment of motor cortex stimulation with tDCS can induce stable relief from PLP in amputees. Neuromodulation targeting the motor cortex appears to be a promising option for the management of this debilitating neuropathic pain condition, which is often refractory to classic pharmacologic and surgical treatments.Perspective: The study describes sustained and immediate effects of motor cortex stimulation by tDCS on postamputation PLP, whose analgesic action seems linked to the motor reactivation of the phantom limb. These results are helpful for the exploitation of tDCS as a therapeutic tool for the management of neuropathic pain. (C) 2015 by the American Pain Society