Brasil-Neto Joaquim P
Laboratory of Neurosciences and Behavior, Department of Physiological Sciences, Universidade de Brasília Brasília, Brazil.
Front Hum Neurosci. 2016 Jun 28;10:323. doi: 10.3389/fnhum.2016.00323. eCollection 2016.
Both invasive and non-invasive motor cortex stimulation techniques have been successfully employed in the treatment of chronic pain, but the precise mechanism of action of such treatments is not fully understood. It has been hypothesized that a mismatch of normal interaction between motor intention and sensory feedback may result in central pain. Sensory feedback may come from peripheral nerves, vision and also from corollary discharges originating from the motor cortex itself. Therefore, a possible mechanism of action of motor cortex stimulation might be corollary discharge reinforcement, which could counterbalance sensory feedback deficiency. In other instances, primary deficiency in the production of corollary discharges by the motor cortex might be the culprit and stimulation of cortical motor areas might then be beneficial by enhancing production of such discharges. Here we review evidence for a possible role of motor cortex corollary discharges upon both the pathophysiology and the response to motor cortex stimulation of different types of chronic pain. We further suggest that the right dorsolateral prefrontal cortex (DLPC), thought to constantly monitor incongruity between corollary discharges, vision and proprioception, might be an interesting target for non-invasive neuromodulation in cases of chronic neuropathic pain.
侵入性和非侵入性运动皮层刺激技术均已成功应用于慢性疼痛的治疗，但此类治疗的确切作用机制尚未完全明确。据推测，运动意图与感觉反馈之间正常相互作用的不匹配可能导致中枢性疼痛。感觉反馈可能来自外周神经、视觉，也可能来自运动皮层自身产生的伴随放电。因此，运动皮层刺激的一种可能作用机制或许是伴随放电增强，这可能抵消感觉反馈不足。在其他情况下，运动皮层产生伴随放电的原发性缺陷可能是罪魁祸首，而刺激皮层运动区可能通过增强此类放电的产生而有益。在此，我们综述了运动皮层伴随放电在不同类型慢性疼痛的病理生理学及对运动皮层刺激的反应中可能发挥作用的证据。我们进一步表明，右侧背外侧前额叶皮层（DLPC）被认为持续监测伴随放电、视觉和本体感觉之间的不一致，在慢性神经性疼痛病例中可能是非侵入性神经调节的一个有趣靶点。
