Usichenko Taras, Laqua René, Leutzow Bianca, Lotze Martin
Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Medicine, University Medicine Greifswald, Sauerbruchstrasse, 17475, Greifswald, Germany.
Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Freiburgstrasse 10, Bern, Switzerland.
Brain Imaging Behav. 2017 Feb;11(1):30-37. doi: 10.1007/s11682-015-9502-5.
Transcutaneous vagal nerve stimulation (TVNS) is a promising complementary method of pain relief. However, the neural networks associated with its analgesic effects are still to be elucidated. Therefore, we conducted two functional magnetic resonance imaging (fMRI) sessions, in a randomized order, with twenty healthy subjects who were exposed to experimental heat pain stimulation applied to the right forearm using a Contact Heat-Evoked Potential Stimulator. While in one session TVNS was administered bilaterally to the concha auriculae with maximal, non-painful intensity, the stimulation device was switched off in the other session (placebo condition). Pain thresholds were measured before and after each session. Heat stimulation elicited fMRI activation in cerebral pain processing regions. Activation magnitude in the secondary somatosensory cortex, posterior insula, anterior cingulate and caudate nucleus was associated with heat stimulation without TVNS. During TVNS, this association was only seen for the right anterior insula. TVNS decreased fMRI signals in the anterior cingulate cortex in comparison with the placebo condition; however, there was no relevant pain reducing effect over the group as a whole. In contrast, TVNS compared to the placebo condition showed an increased activation in the primary motor cortex, contralateral to the site of heat stimulation, and in the right amygdala. In conclusion, in the protocol used here, TVNS specifically modulated the cerebral response to heat pain, without having a direct effect on pain thresholds.
经皮迷走神经刺激(TVNS)是一种很有前景的疼痛缓解辅助方法。然而,与其镇痛效果相关的神经网络仍有待阐明。因此,我们对20名健康受试者进行了两轮功能磁共振成像(fMRI)实验,实验顺序随机,受试者使用接触式热诱发电位刺激器接受施加于右前臂的实验性热痛刺激。在其中一轮实验中,以最大非疼痛强度对双侧耳甲进行TVNS,在另一轮实验中关闭刺激装置(安慰剂条件)。在每轮实验前后测量疼痛阈值。热刺激在大脑疼痛处理区域引发fMRI激活。在没有TVNS的情况下,次级体感皮层、后岛叶、前扣带回和尾状核的激活程度与热刺激有关。在TVNS期间,这种关联仅在右侧前岛叶中可见。与安慰剂条件相比,TVNS使前扣带回皮层的fMRI信号降低;然而,对整个组而言没有相关的疼痛减轻效果。相比之下,与安慰剂条件相比,TVNS在热刺激部位对侧的初级运动皮层和右侧杏仁核中显示出激活增加。总之,在此处使用的方案中,TVNS特异性地调节了大脑对热痛的反应,而对疼痛阈值没有直接影响。
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