Phantom limb pain, cortical reorganization and the therapeutic effect of mental imagery.
Phantom limb pain, cortical reorganization and the therapeutic effect of mental imagery.
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DOI：
10.1093/brain/awn124
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发表时间：
2008-08
期刊：
影响因子：
14.5
通讯作者：
Nurmikko, T.
中科院分区：
文献类型：
--
作者：
Maclver, K.;Lloyd, D. M.;Kelly, S.;Roberts, N.;Nurmikko, T.
使用功能磁共振成像（fMRI），我们调查了13个上肢截肢与幻肢痛（PLP）在手和唇运动，之前和之后，密集的6周的心理意象训练。在训练之前，激活引起的唇荷包显示的证据皮质重组的运动（M1）和体感（S1）皮质，扩大从唇区到手区，这与疼痛评分。此外，在幻手的想象运动和完整手的执行运动中，组图不仅显示双侧M1和S1手区的激活，而且还显示唇区的激活，呈现双向重组过程。在健康的参与者，激活在唇荷包和想象和执行的非优势手的运动仅限于各自的皮质代表区。训练后，患者报告持续疼痛和恶化的强度和不愉快程度显著降低，相应地消除了皮质重组。事后分析表明，持续疼痛的强度，而不是恶化，与皮质重组减少。这项研究的结果增加了我们目前对PLP病理生理学的理解，强调了该患者人群神经可塑性变化的可逆性，同时提供了一种新的，简单的疼痛缓解方法。
Using functional MRI (fMRI) we investigated 13 upper limb amputees with phantom limb pain (PLP) during hand and lip movement, before and after intensive 6-week training in mental imagery. Prior to training, activation elicited during lip purse showed evidence of cortical reorganization of motor (M1) and somatosensory (S1) cortices, expanding from lip area to hand area, which correlated with pain scores. In addition, during imagined movement of the phantom hand, and executed movement of the intact hand, group maps demonstrated activation not only in bilateral M1 and S1 hand area, but also lip area, showing a two-way process of reorganization. In healthy participants, activation during lip purse and imagined and executed movement of the non-dominant hand was confined to the respective cortical representation areas only. Following training, patients reported a significant reduction in intensity and unpleasantness of constant pain and exacerbations, with a corresponding elimination of cortical reorganization. Post hoc analyses showed that intensity of constant pain, but not exacerbations, correlated with reduction in cortical reorganization. The results of this study add to our current understanding of the pathophysiology of PLP, underlining the reversibility of neuroplastic changes in this patient population while offering a novel, simple method of pain relief.
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