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肌筋膜触发点按压对慢性颈痛的缓解作用通过前额叶皮质和自主神经系统实现：一项初步研究

Compression at Myofascial Trigger Point on Chronic Neck Pain Provides Pain Relief through the Prefrontal Cortex and Autonomic Nervous System: A Pilot Study.

作者信息

Morikawa Yoshiki, Takamoto Kouich, Nishimaru Hiroshi, Taguchi Toru, Urakawa Susumu, Sakai Shigekazu, Ono Taketoshi, Nishijo Hisao

机构信息

System Emotional Science, Graduate School of Medicine and Pharmaceutical Sciences, University of ToyamaToyama, Japan.

Department of Judo Neurophysiotherapy, Graduate School of Medicine and Pharmaceutical Sciences, University of ToyamaToyama, Japan.

出版信息

Front Neurosci. 2017 Apr 11;11:186. doi: 10.3389/fnins.2017.00186. eCollection 2017.

DOI:10.3389/fnins.2017.00186
PMID:28442987
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5386976/
Abstract

Compression at myofascial trigger points (MTrPs), known as "ischemic compression," has been reported to provide immediate relief of musculoskeletal pain and reduce the sympathetic activity that exacerbates chronic pain. We conducted a pilot study to investigate the possible involvement of the prefrontal cortex in pain relief obtained by MTrP compression in the present study, and analyzed the relationships among prefrontal hemodynamic activity, activity of the autonomic nervous system, and subjective pain in patients with chronic neck pain, with and without MTrP compression. Twenty-one female subjects with chronic neck pain were randomly assigned to two groups: MTrP compression ( = 11) or Non-MTrP compression ( = 10). Compression for 30 s was conducted 4 times. During the experiment, prefrontal hemodynamic activity [changes in Oxy-hemoglobin (Hb), Deoxy-Hb, and Total-Hb concentrations] and autonomic activity based on heart rate variability (HRV) were monitored by using near infrared spectroscopy (NIRS) and electrocardiography (ECG), respectively. The results indicated that MTrP compression significantly reduced subjective pain compared with Non-MTrP compression. The spectral frequency-domain analyses of HRV indicated that a low frequency (LF) component of HRV was decreased, and a high frequency (HF) component of HRV was increased during MTrP compression, while LF/HF ratio was decreased during MTrP compression. In addition, prefrontal hemodynamic activity was significantly decreased during MTrP compression compared with Non-MTrP compression. Furthermore, changes in autonomic activity were significantly correlated with changes in subjective pain and prefrontal hemodynamic activity. Along with previous studies indicating a role for sympathetic activity in the exacerbation of chronic pain, the present results suggest that MTrP compression in the neck region alters the activity of the autonomic nervous system via the prefrontal cortex to reduce subjective pain.

摘要

肌筋膜触发点（MTrP）处的按压，即所谓的“缺血性按压”，据报道可立即缓解肌肉骨骼疼痛，并减少加剧慢性疼痛的交感神经活动。在本研究中，我们进行了一项初步研究，以调查前额叶皮层在通过MTrP按压获得的疼痛缓解中可能的参与情况，并分析了慢性颈痛患者在有和没有MTrP按压时前额叶血流动力学活动、自主神经系统活动和主观疼痛之间的关系。21名患有慢性颈痛的女性受试者被随机分为两组：MTrP按压组（n = 11）或非MTrP按压组（n = 10）。进行4次30秒的按压。在实验过程中，分别使用近红外光谱（NIRS）和心电图（ECG）监测前额叶血流动力学活动[氧合血红蛋白（Hb）、脱氧血红蛋白和总血红蛋白浓度的变化]以及基于心率变异性（HRV）的自主神经活动。结果表明，与非MTrP按压相比，MTrP按压显著减轻了主观疼痛。HRV的频谱频域分析表明，在MTrP按压期间，HRV的低频（LF）成分降低，高频（HF）成分增加，而在MTrP按压期间LF/HF比值降低。此外，与非MTrP按压相比，MTrP按压期间前额叶血流动力学活动显著降低。此外，自主神经活动的变化与主观疼痛和前额叶血流动力学活动的变化显著相关。与先前表明交感神经活动在慢性疼痛加剧中的作用的研究一致，目前的结果表明，颈部区域的MTrP按压通过前额叶皮层改变自主神经系统的活动，以减轻主观疼痛。

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