Analgesic and placebo effects of thalamic stimulation
Analgesic and placebo effects of thalamic stimulation
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DOI：
10.1016/s0304-3959(03)00265-3
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发表时间：
2003-10-01
期刊：
影响因子：
7.4
通讯作者：
Duncan, GH
中科院分区：
文献类型：
--
作者：
Marchand, S;Kupers, RC;Duncan, GH
许多临床研究已经报道了感觉丘脑刺激成功缓解慢性疼痛。然而，即使随着传感器的广泛使用，丘脑刺激作为缓解慢性疼痛的临床工具，结果仍然不一致。这种差异可能是因为大多数研究是病例报告或回顾性分析，这些研究通常使用不精确的疼痛测量，无法对疼痛缓解进行严格的统计学评价。这些研究都没有测量刺激对临床疼痛的影响，每天超过几个小时，这是一个重要的方面，因为临床疼痛可能会随着时间的推移而变化。此外，很少包括安慰剂对照。在目前的研究中，我们在2周的时间内测量了患者在家中的疼痛感知，包括在感觉丘脑正常刺激的日子和没有刺激的日子。患者也来到实验室，评估丘脑和安慰剂刺激对临床疼痛、实验性热痛、无害空气抽吸和视觉刺激的影响。还探讨了丘脑和安慰剂刺激期间感知的感觉异常与镇痛疗效之间的潜在关系。我们发现，丘脑刺激显着影响临床和实验的疼痛感知，但也存在一个重要的安慰剂成分。另一方面，无论是丘脑或安慰剂刺激影响喷气和视觉评级，这表明该效果特别适用于疼痛，因此不是由注意力的一般变化引起的。在安慰剂操作期间引起的感觉异常水平也与安慰剂疼痛缓解程度直接相关。这些结果表明，丘脑刺激产生一个小的，但显着减少疼痛的感觉，但也存在一个显着的安慰剂效应。(C)2003年国际疼痛研究协会。Elsevier B.V.出版，保留所有权利。
Numerous clinical studies have reported successful relief of chronic pain with sensory thalamic stimulation. However, even with the extensive use of sensor), thalamic stimulation as a clinical tool in the relief of chronic pain, the results are still inconsistent. This discrepancy could probably be explained by the fact that the majority of these studies are case reports or retrospective analyses, which have often used imprecise pain measurements that do not allow a rigorous statistical evaluation of pain relief. None of these studies measured the effect of stimulation on clinical pain for longer than a few hours per day, which is an important aspect considering that clinical pain can vary over time. Moreover, placebo controls are seldom included. In the current study, we measured patients' pain perception at home over a 2-week period, both during days of normal stimulation of the sensory thalamus and during days without stimulation. Patients also came to the laboratory to assess the effects of thalamic and placebo stimulation on clinical pain, experimental heat pain, innocuous air puff and visual stimulation. A potential relation between the perceived paresthesia and analgesic efficacy during thalamic and placebo stimulation was also explored. We found that thalamic stimulation significantly affected clinical and experimental pain perception, but that an important placebo component also exists. On the other hand, neither thalamic nor placebo stimulation affected air puff and visual ratings, suggesting that the effect applies specifically to pain and hence is not caused by a general change in attention. The level of paresthesia elicited during the placebo manipulation was also directly correlated with the degree of placebo pain relief. These results suggest that thalamic stimulation produces a small but significant reduction in pain perception, but that a significant placebo effect also exists. (C) 2003 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.