Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany Ospedale San Camillo, Instituto di Ricovero e Cura a Carattere Scientifico, Venezia, Italy Traumatology Hospital of the University of Tübingen, Germany Department of Clinical and Cognitive Neuroscience, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany Functional Imaging, Institute for Diagnostic Radiology and Neuroradiology, University of Greifswald, Germany.
Pain. 2010 Oct;151(1):69-76. doi: 10.1016/j.pain.2010.06.022. Epub 2010 Jul 13.
A combination therapy of morphine with an NMDA-receptor antagonist might be more effective than morphine without a NMDA-receptor antagonist for the relief of neuropathic pain in patients with complex regional pain syndrome (CRPS). In order to test the efficacy of this combination therapy we performed a double-blind randomized placebo-controlled study on patients suffering from CRPS of the upper extremity. We used functional magnetic resonance imaging during movement of the affected and unaffected upper hand before and after a treatment regimen of 49 days that contrasted morphine and an NMDA-receptor antagonist with morphine and placebo. We postulated superior pain relief for the combination therapy and concomitant changes in brain areas associated with nociceptive processing. Only the combination therapy reduced pain at rest and during movement, and disability. After treatment, activation in the contralateral primary somatosensory (cS1) and anterior cingulate cortex was significantly reduced when the affected hand was moved. Pain relief during therapy was related to decreased activation in cS1 and secondary somatosensory cortex (S2). Our data suggest that the combination of morphine with an NMDA-receptor antagonist significantly affects the cerebral processing of nociceptive information in CRPS. The correlation of pain relief and decrease in cortical activity in cS1 and S2 is in accordance with the expected impact of the NMDA-receptor antagonist on cerebral pain processing with emphasis on sensory-discriminative aspects of pain.
阿联合治疗吗啡与 NMDA 受体拮抗剂可能比吗啡更有效无 NMDA 受体拮抗剂为缓解神经病理性疼痛患者复杂区域疼痛综合征 (CRPS)。为了测试这种联合治疗的疗效，我们进行了一项双盲随机安慰剂对照研究上肢 CRPS 患者。我们使用功能磁共振成像运动过程中受影响和未受影响的上手之前和之后 49 天的治疗方案，对比吗啡和 NMDA 受体拮抗剂与吗啡和安慰剂。我们假设联合治疗有更好的镇痛效果，并伴有与伤害性处理相关的大脑区域的变化。只有联合治疗减轻疼痛休息时和运动时，和残疾。治疗后，对侧初级躯体感觉皮层（cS1）和前扣带回皮质的激活明显减少当受影响的手被移动。治疗期间的疼痛缓解与 cS1 和次级躯体感觉皮层（S2）的激活减少有关。我们的数据表明，吗啡与 NMDA 受体拮抗剂的联合显著影响大脑处理伤害性信息在 CRPS。疼痛缓解与 cS1 和 S2 皮质活动减少的相关性与 NMDA 受体拮抗剂对大脑疼痛处理的预期影响一致，强调疼痛的感觉辨别方面。
