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大麻素对伤害感受系统的影响:一项针对继发进展型多发性硬化症患者的神经生理学研究。

Cannabinoid-induced effects on the nociceptive system: a neurophysiological study in patients with secondary progressive multiple sclerosis.

作者信息

Conte Antonella, Bettolo Chiara Marini, Onesti Emanuela, Frasca Vittorio, Iacovelli Elisa, Gilio Francesca, Giacomelli Elena, Gabriele Maria, Aragona Massimiliano, Tomassini Valentina, Pantano Patrizia, Pozzilli Carlo, Inghilleri Maurizio

机构信息

Department of Neurological Sciences, University of Rome "Sapienza", Viale dell'Università 30, 00185 Rome, Italy.

出版信息

Eur J Pain. 2009 May;13(5):472-7. doi: 10.1016/j.ejpain.2008.05.014. Epub 2008 Jul 7.

Abstract

Although clinical studies show that cannabinoids improve central pain in patients with multiple sclerosis (MS) neurophysiological studies are lacking to investigate whether they also suppress these patients' electrophysiological responses to noxious stimulation. The flexion reflex (FR) in humans is a widely used technique for assessing the pain threshold and for studying spinal and supraspinal pain pathways and the neurotransmitter system involved in pain control. In a randomized, double-blind, placebo-controlled, cross-over study we investigated cannabinoid-induced changes in RIII reflex variables (threshold, latency and area) in a group of 18 patients with secondary progressive MS. To investigate whether cannabinoids act indirectly on the nociceptive reflex by modulating lower motoneuron excitability we also evaluated the H-reflex size after tibial nerve stimulation and calculated the H wave/M wave (H/M) ratio. Of the 18 patients recruited and randomized 17 completed the study. After patients used a commercial delta-9-tetrahydrocannabinol (THC) and cannabidiol mixture as an oromucosal spray the RIII reflex threshold increased and RIII reflex area decreased. The visual analogue scale score for pain also decreased, though not significantly. Conversely, the H/M ratio measured before patients received cannabinoids remained unchanged after therapy. In conclusion, the cannabinoid-induced changes in the RIII reflex threshold and area in patients with MS provide objective neurophysiological evidence that cannabinoids modulate the nociceptive system in patients with MS.

摘要

尽管临床研究表明大麻素可改善多发性硬化症(MS)患者的中枢性疼痛,但缺乏神经生理学研究来调查它们是否也能抑制这些患者对有害刺激的电生理反应。人类的屈肌反射(FR)是一种广泛用于评估疼痛阈值以及研究脊髓和脊髓上疼痛通路以及参与疼痛控制的神经递质系统的技术。在一项随机、双盲、安慰剂对照的交叉研究中,我们调查了18例继发进展型MS患者使用大麻素后RIII反射变量(阈值、潜伏期和面积)的变化。为了研究大麻素是否通过调节下运动神经元兴奋性间接作用于伤害性反射,我们还评估了胫神经刺激后的H反射大小,并计算了H波/M波(H/M)比值。在招募并随机分组的18例患者中,17例完成了研究。患者使用商业性的Δ-9-四氢大麻酚(THC)和大麻二酚混合物作为口腔黏膜喷雾剂后,RIII反射阈值升高,RIII反射面积减小。疼痛的视觉模拟量表评分也有所下降,尽管不显著。相反,患者接受大麻素治疗前测得的H/M比值在治疗后保持不变。总之,大麻素引起的MS患者RIII反射阈值和面积的变化提供了客观的神经生理学证据,表明大麻素可调节MS患者的伤害性系统。

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