Brain Rehabilitation and Neuroplasticity Unit, School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia.
School of Health and Rehabilitations Sciences, The University of Queensland, Brisbane, Queensland, Australia.
Pain Med. 2018 Jun 1;19(6):1227-1236. doi: 10.1093/pm/pnx168.
Neuromodulation is increasingly investigated for the treatment of low back pain (LBP). However, the neurophysiological effects of common neuromodulatory techniques (anodal transcranial direct current stimulation [tDCS] and peripheral electrical stimulation [PES]) have not been investigated in people with chronic LBP. Here we aimed to compare the effect of three neuromodulatory protocols (anodal tDCS, high intensity PES, and a priming protocol of combined tDCS/PES) on primary motor cortex (M1) excitability in people with and without chronic LBP.
Cross-sectional.
University laboratory.
Ten individuals with chronic LBP and 10 pain-free controls.
Participants received four interventions in random order across separate sessions: 1) anodal tDCS to M1 + PES to the back muscles; 2) tDCS + sham PES; 3) sham tDCS + PES; or 4) sham tDCS + sham PES. Motor cortical excitability (map volume, discrete map peaks, and cortical silent period [CSP]) was measured before and after each intervention.
Anodal tDCS increased M1 excitability (increased map volume and reduced CSP) in controls but had no effect in the LBP group. PES reduced M1 excitability in both groups. The combined tDCS + PES treatment increased M1 excitability in the LBP group but had no effect in controls.
The neurophysiological response to common neuromodulatory treatments differs between people with and without LBP. This has relevance for the design and tailoring of neuromodulation in pain. Further, if the goal of treatment is to increase M1 excitability, a priming protocol (e.g., combined tDCS + PES) may be more effective than tDCS alone.
神经调节越来越多地被用于治疗下腰痛（LBP）。然而，常见神经调节技术（阳极经颅直流电刺激（tDCS）和外周电刺激（PES））的神经生理效应尚未在慢性 LBP 患者中得到研究。在这里，我们旨在比较三种神经调节方案（阳极 tDCS、高强度 PES 和 tDCS/PES 联合激发方案）对慢性 LBP 患者和无慢性 LBP 患者的初级运动皮层（M1）兴奋性的影响。
横断面研究。
大学实验室。
10 名慢性 LBP 患者和 10 名无痛对照者。
参与者在四个单独的疗程中随机接受四种干预措施：1）阳极 tDCS 至 M1+PES 至背部肌肉；2）tDCS+假 PES；3）假 tDCS+PES；或 4）假 tDCS+假 PES。在每次干预前后测量运动皮层兴奋性（图体积、离散图峰和皮层静息期（CSP））。
阳极 tDCS 增加了对照组 M1 的兴奋性（增加了图体积并减少了 CSP），但对 LBP 组没有影响。PES 降低了两组的 M1 兴奋性。联合 tDCS+PES 治疗增加了 LBP 组的 M1 兴奋性，但对对照组没有影响。
有和没有 LBP 的人对常见神经调节治疗的神经生理反应不同。这与疼痛的神经调节设计和定制有关。此外，如果治疗的目的是增加 M1 的兴奋性，那么激发方案（例如，联合 tDCS+PES）可能比单独使用 tDCS 更有效。
