Bolognini Nadia, Spandri Viviana, Ferraro Francesco, Salmaggi Andrea, Molinari Alessandro C L, Fregni Felipe, Maravita Angelo
Department of Psychology, University of Milano-Bicocca, Milano, Italy; Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milano, Italy.
Department of Psychology, University of Milano-Bicocca, Milano, Italy; Department of Neuroscience, Azienda Ospedaliera "Alessandro Manzoni," Lecco, Italy.
J Pain. 2015 Jul;16(7):657-65. doi: 10.1016/j.jpain.2015.03.013. Epub 2015 Apr 8.
The study explored the analgesic effects of transcranial direct current stimulation (tDCS) over the motor cortex on postamputation phantom limb pain (PLP). Eight subjects with unilateral lower or upper limb amputation and chronic PLP were enrolled in a crossover, double-blind, sham-controlled treatment program. For 5 consecutive days, anodal (active or sham) tDCS was applied over the motor cortex for 15 minutes at an intensity of 1.5 mA. The 5-day treatment with active, but not sham, tDCS induced a sustained decrease in background PLP and in the frequency of PLP paroxysms, which lasted for 1 week after the end of treatment. Moreover, on each day of active tDCS, patients reported an immediate PLP relief, along with an increased ability to move their phantom limb. Patients' immediate responses to sham tDCS, on the contrary, were variable, marked by an increase or decrease of PLP levels from baseline. These results show that a 5-day treatment of motor cortex stimulation with tDCS can induce stable relief from PLP in amputees. Neuromodulation targeting the motor cortex appears to be a promising option for the management of this debilitating neuropathic pain condition, which is often refractory to classic pharmacologic and surgical treatments.
The study describes sustained and immediate effects of motor cortex stimulation by tDCS on postamputation PLP, whose analgesic action seems linked to the motor reactivation of the phantom limb. These results are helpful for the exploitation of tDCS as a therapeutic tool for the management of neuropathic pain.
本研究探讨了经颅直流电刺激（tDCS）作用于运动皮层对截肢后幻肢痛（PLP）的镇痛效果。八名单侧下肢或上肢截肢且患有慢性幻肢痛的受试者参加了一项交叉、双盲、假刺激对照治疗方案。连续5天，以1.5毫安的强度将阳极（活性或假刺激）tDCS作用于运动皮层15分钟。活性tDCS而非假刺激tDCS进行的为期5天的治疗使背景幻肢痛和幻肢痛发作频率持续降低，在治疗结束后持续1周。此外，在活性tDCS治疗的每一天，患者报告幻肢痛立即缓解，同时幻肢移动能力增强。相反，患者对假刺激tDCS的即时反应各不相同，其特征是幻肢痛水平相对于基线有所增加或降低。这些结果表明，用tDCS对运动皮层进行为期5天的刺激可使截肢者的幻肢痛得到稳定缓解。针对运动皮层的神经调节似乎是治疗这种使人衰弱的神经性疼痛疾病的一个有前景的选择，这种疾病通常对传统药物和手术治疗无效。
该研究描述了tDCS对运动皮层刺激对截肢后幻肢痛的持续和即时效果，其镇痛作用似乎与幻肢的运动再激活有关。这些结果有助于将tDCS开发为治疗神经性疼痛的一种治疗工具。
