不同频率电刺激诱导长时程痛觉敏化的分析比较
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摘要
目的:分析应用不同频率条件性电刺激(Conditioning electrical stimulation,CES)诱导长时程痛觉敏化及各测量参数间的相关性。方法:20位受试者均接受按随机顺序设定的10 Hz,100 Hz,200 Hz CES和对照实验。通过测量皮肤血流和温度来观测皮肤的炎症反应。应用单次脉冲电刺激(Single electrical stimulation,SES)测量CES部位(同位)的痛觉变化,在CES部位周围(异位)用30 g和50 g的针刺刺激器测量针刺觉和医用棉签测量轻触觉的变化。采用Pearson相关性检验判断测量参数间的相关性。结果:与对照期相比,针刺觉和轻触觉在三种CES后均升高;各实验期的同位痛觉变化无统计学差别。皮肤血流在10 Hz和200 Hz CES后高于对照期。相关性分析显示:皮肤血流和温度与轻触觉和SES的疼痛评分之间未发现相关性;同位的SES痛觉变化与异位针刺觉的变化存在较高相关性,与轻触觉的变化在10 Hz和100 Hz实验期存在弱相关性;异位的轻触觉和针刺觉变化在10 Hz、100 Hz和对照期中,发现存在一定的相关性。结论:高频(200 Hz)和中频(10 Hz)CES可引起与100 Hz CES相似的异位痛觉增强。10 Hz CES由于其更加接近C-纤维痛觉感受器在炎症状态下的放电频率,因此可以成为另一种电刺激方案应用到长时程痛觉敏化模型中。
Objective: Compare different frequencies of conditioning electrical stimulation(CES) in inducing the long term potentiation(LTP)-like pain facilitation and analyse the correlation of measured parameters. Methods: Each of the 20 subjects participated 4 sessions(10 Hz, 100 Hz, 200 Hz, and Control session) in a random order. Superficial blood flow(SBF) and skin temperature(ST) were measured. The single electrical stimulation(SES) was used for measuring pain sensation at the conditioned sites(homotopic); the pinprick stimuli(30 g and 50 g) and Q-tip were used for measuring pain sensations around the conditioned sites(heterotopic). Pearson correlation test was used to explore the correlations among parameters. Results: Compared to the control session, the pain sensations to pinprick and Q-tip stimuli increased after all the three categories of CES. Pain sensations to SES were not different between sessions. The superficial blood flow after 10 Hz and 200 Hz CES was higher than the control session. Pearson correlations showed that SBF and ST were not significantly correlated with light touch sensation and SES pain ratings; the homotopic SES pain ratings were significantly correlated with heterotopic pinprick pain ratings, and light touch ratings in 10 Hz and 100 Hz sessions; the heterotopic pinprick pain ratings were significantly correlated with light touch ratings in 10 Hz, 100 Hz and control sessions. Conclusion: Compared with 100 Hz CES, high(200 Hz) and intermediate(10 Hz) frequency CES have similar effect in inducing LTP-like pain changes.
Objective: Compare different frequencies of conditioning electrical stimulation(CES) in inducing the long term potentiation(LTP)-like pain facilitation and analyse the correlation of measured parameters. Methods: Each of the 20 subjects participated 4 sessions(10 Hz, 100 Hz, 200 Hz, and Control session) in a random order. Superficial blood flow(SBF) and skin temperature(ST) were measured. The single electrical stimulation(SES) was used for measuring pain sensation at the conditioned sites(homotopic); the pinprick stimuli(30 g and 50 g) and Q-tip were used for measuring pain sensations around the conditioned sites(heterotopic). Pearson correlation test was used to explore the correlations among parameters. Results: Compared to the control session, the pain sensations to pinprick and Q-tip stimuli increased after all the three categories of CES. Pain sensations to SES were not different between sessions. The superficial blood flow after 10 Hz and 200 Hz CES was higher than the control session. Pearson correlations showed that SBF and ST were not significantly correlated with light touch sensation and SES pain ratings; the homotopic SES pain ratings were significantly correlated with heterotopic pinprick pain ratings, and light touch ratings in 10 Hz and 100 Hz sessions; the heterotopic pinprick pain ratings were significantly correlated with light touch ratings in 10 Hz, 100 Hz and control sessions. Conclusion: Compared with 100 Hz CES, high(200 Hz) and intermediate(10 Hz) frequency CES have similar effect in inducing LTP-like pain changes.
引文
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[3]巩克瑞,李菁锦.神经病理性疼痛与长时程增强.中国康复理论与实践,2005,11(12):994~995.
[4]Kim HY,Jun J,Wang J,et al.Induction of long-term potentiation and long-term depression is cell-type specific in the spinal cord.Pain,2015,156(4):618~625.
[5]Liu X,Sandkühler J.Characterization of long-term potentiation of C-fiber-evoked potentials in spinal dorsal horn of adult rat:essential role of NK1 and NK2 receptors.Journal of neurophysiology,1997,78(4):1973~1982.
[6]谢长春,高崇荣,卢振和,等.不同频率脉冲射频对大鼠脊髓背角C-纤维诱发电位长时程增强的影响.中国疼痛医学杂志,2006,12(6):325~328.
[7]邢国刚,刘风雨,姚磊,等.神经病理性疼痛大鼠脊髓背角突触传递的长时程可塑性变化.北京大学学报(医学版),2003,35(3):226~230.
[8]Klein T,Magerl W,Hopf HC,et al.Perceptual correlates of nociceptive long-term potentiation and long-term depression in humans.2004/01/30J Neurosci,2004,24(4):964~971.
[9]Ji R-R,Kohno T,Moore K a,et al.Central sensitization and LTP:do pain and memory share similar mechanisms.Trends in Neurosciences,2003,26(12):696~705.
[10]Lever IJ,Bradbury EJ,Cunningham JR,et al.Brainderived neurotrophic factor is released in the dorsal horn by distinctive patterns of afferent fiber stimulation.2001,21(12):4469~4477.
[11]Biurrun Manresa Ja,M?rch CD,Andersen OK.Long-term facilitation of nociceptive withdrawal reflexes following low-frequency conditioning electrical stimulation:a new model for central sensitization in humans.European journal of pain(London,England),2010,14(8):822~831.
[12]Han HC,Lee DH,Chung JM.Characteristics of ectopic discharges in a rat neuropathic pain model.Pain,2000,84(2–3):253~261.
[13]Xiao WH,Bennett GJ.Persistent low-frequency spontaneous discharge in A-fiber and C-fiber primary afferent neurons during an inflammatory pain condition.Anesthesiology,2007,107(5):813~821.
[14]Weidner C,Schmelz M,Schmidt R,et al.Neural signal processing:the underestimated contribution of peripheral human C-fibers.The Journal of neuroscience:the official journal of the Society for Neuroscience,2002,22(15):6704~6712.
[15]Liu H,Brown JL,Jasmin L,et al.Synaptic relationship between substance P and the substance P receptor:light and electron microscopic characterization of the mismatch between neuropeptides and their receptors.Proceedings of the National Academy of Sciences of the United States of America,1994,91(3):1009~1013.
[16]Brain SD,Williams TJ.Substance P regulates the vasodilator activity of calcitonin gene-related peptide.Nature,1988,335:73~75.
[17]Dusch M,Schley M,Rukwied R,et al.Rapid flare development evoked by current frequency-dependent stimulation analyzed by full-field laser perfusion imaging.Neuroreport,2007,18(11):1101~1105.
[18]Raymond SA,Thalhammer JG,Popitz-Bergez F,et al.Changes in axonal impulse conduction correlate with sensory modality in primary afferent fibers in the rat.Brain research,1990,526(2):318~321.
[19]Henrich F,Magerl W,Klein T,et al.Capsaicinsensitive C-and A-fibre nociceptors control long-term potentiation-like pain amplification in humans.Brain:a journal of neurology,2015,138(Pt 9):2505~2520.
[20]Santos S F A,Rebelo S,Derkach V A,et al.Excitatory interneurons dominate sensory processing in the spinal substantia gelatinosa of rat.The Journal of physiology,2007,581(Pt 1):241~254.
[21]Serra J,Bostock H,SolàR,et al.Microneurographic identification of spontaneous activity in C-nociceptors in neuropathic pain states in humans and rats.Pain,2012,153(1):42~55.
[22]Sumikura H,Andersen O K,Drewes A M,et al.Spatial and temporal profiles of flare and hyperalgesia after intradermal capsaicin.Pain,2003,105(1–2):285~291.
[23]Lewis T.The blood vessels of the human skin and their response.Shaw,London:1927.
[24]Van den Broeke EN,Van Heck CH,Ceelen LAJM,et al.The effect of high-frequency conditioning stimulation of human skin on reported pain intensity and event-related potentials.Journal of neurophysiology,2012,108(8):2276~2281.
[25]De Col R,Maih?fner C.Centrally mediated sensory decline induced by differential C-fiber stimulation.Pain,2008,138(3):556~564.