Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, United States.
Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Baltimore, MD, United States.
Pain. 2018 Dec;159(12):2486-2492. doi: 10.1097/j.pain.0000000000001350.
The left dorsolateral prefrontal cortex (DLPFC) is involved in the experience and modulation of pain, and may be an important node linking pain and cognition. Repetitive transcranial magnetic stimulation (rTMS) to the left DLPFC can reduce chronic and experimental pain. However, whether left DLPFC rTMS can influence the development of chronic pain is unknown. Using repeated intramuscular injection of nerve growth factor to induce the development of sustained muscle pain (lasting weeks), 30 healthy individuals were randomized to receive 5 consecutive daily treatments of active or sham left DLPFC rTMS, starting before the first nerve growth factor injection on day 0. Muscle soreness and pain severity were collected daily for 14 days and disability on every alternate day. Before the first and 1 day after the last rTMS session, anxiety, depression, affect, pain catastrophizing, and cognitive performance on the attention network test were assessed. Left DLPFC rTMS treatment compared with sham was associated with reduced muscle soreness, pain intensity, and painful area (P < 0.05), and a similar trend was observed for disability. These effects were most evident during the days rTMS was applied lasting up to 3 days after intervention. Depression, anxiety, pain catastrophizing, and affect were unchanged. There was a trend toward improved cognitive function with rTMS compared with sham (P = 0.057). These data indicate that repeated left DLPFC rTMS reduces the pain severity in a model of prolonged muscle pain. The findings may have implications for the development of sustained pain in clinical populations.
左侧背外侧前额叶皮层(DLPFC)参与疼痛的体验和调节,可能是连接疼痛和认知的重要节点。对左侧 DLPFC 进行重复经颅磁刺激(rTMS)可减轻慢性和实验性疼痛。然而,左侧 DLPFC rTMS 是否会影响慢性疼痛的发展尚不清楚。使用重复的肌肉内注射神经生长因子来诱导持续性肌肉疼痛(持续数周),将 30 名健康个体随机分为接受连续 5 天的左侧 DLPFC rTMS 治疗或假刺激治疗,在第 0 天第一次神经生长因子注射之前开始。每天收集 14 天的肌肉酸痛和疼痛严重程度,每隔一天收集残疾情况。在第一次 rTMS 治疗前和最后一次 rTMS 治疗后 1 天,评估焦虑、抑郁、情绪、疼痛灾难化和注意网络测试的认知表现。与假刺激相比,左侧 DLPFC rTMS 治疗与肌肉酸痛、疼痛强度和疼痛区域减少相关(P < 0.05),残疾情况也存在类似趋势。这些影响在 rTMS 应用期间最为明显,持续时间长达干预后 3 天。抑郁、焦虑、疼痛灾难化和情绪没有变化。与假刺激相比,rTMS 治疗有改善认知功能的趋势(P = 0.057)。这些数据表明,重复的左侧 DLPFC rTMS 可减轻慢性肌肉疼痛模型中的疼痛严重程度。这些发现可能对临床人群中持续性疼痛的发展有影响。
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