Neuropharmacological basis of rTMS-induced analgesia: The role of endogenous opioids
Neuropharmacological basis of rTMS-induced analgesia: The role of endogenous opioids
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DOI：
10.1016/j.pain.2010.10.032
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发表时间：
2011-02-01
期刊：
影响因子：
7.4
通讯作者：
Bouhassira, Didier
中科院分区：
文献类型：
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作者：
de Andrade, Daniel Ciampi;Mhalla, Alaa;Bouhassira, Didier
我们研究了内源性阿片系统在重复经颅磁刺激(RTMS)镇痛效应中的作用。我们采用随机双盲交叉设计，在健康志愿者中比较了纳洛酮或安慰剂治疗前后刺激运动皮质(M1)或背外侧前额叶皮质(DLPFC)的止痛效果。在间隔2周的两次实验中，随机选择3组志愿者，分别给予右侧M1的主动刺激(频率10 Hz，80%运动阈值强度，1500次/次)、右侧DLPFC的主动刺激或假刺激。以冷痛阈值和一系列恒温冷刺激(5、10、15℃)引起的疼痛强度为指标评价rTMS的镇痛效果。分别于静脉注射纳洛酮(0.1 mg/kg，然后以0.1 mg/kg/h持续滴注，直至rTMS结束)或安慰剂(生理盐水)前和注射后1h在左侧大鱼际隆起处进行测量。注射纳洛酮可显著降低刺激M1的镇痛作用，但不改变rTMS对DLPFC或假rTMS的作用。本研究首次证实了内源性阿片系统参与rTMS的镇痛作用。纳洛酮对刺激M1和DLPFC的不同作用提示，刺激这两个皮质部位所产生的镇痛作用可能是通过不同的机制实现的。(C)2010年，由爱思唯尔公司代表国际疼痛研究协会出版。
We investigated the role of endogenous opioid systems in the analgesic effects induced by repetitive transcranial magnetic stimulation (rTMS). We compared the analgesic effects of motor cortex (M1) or dorsolateral prefrontal cortex (DLPFC) stimulation before and after naloxone or placebo treatment, in a randomized, double-blind crossover design, in healthy volunteers. Three groups of 12 volunteers were selected at random and given active stimulation (frequency 10 Hz, at 80% motor threshold intensity, 1500 pulses per session) of the right M1, active stimulation of the right DLPFC, or sham stimulation, during two experimental sessions 2 weeks apart. Cold pain thresholds and the intensity of pain induced by a series of fixed-temperature cold stimuli (5, 10, and 15 degrees C) were used to evaluate the analgesic effects of rTMS. Measurements were made at the left thenar eminence, before and 1 hour after the intravenous injection of naloxone (bolus of 0.1 mg/kg followed by a continuous infusion of 0.1 mg/kg/h until the end of rTMS) or placebo (saline). Naloxone injection significantly decreased the analgesic effects of M1 stimulation, but did not change the effects of rTMS of the DLPFC or sham rTMS. This study demonstrates, for the first time, the involvement of endogenous opioid systems in rTMS-induced analgesia. The differential effects of naloxone on M1 and DLPFC stimulation suggest that the analgesic effects induced by the stimulation of these 2 cortical sites are mediated by different mechanisms. (C) 2010 Published by Elsevier B.V. on behalf of International Association for the Study of Pain.