Section of Neurophysiopathology, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 20142, Pisa, Italy.
"Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan & ASST Santi Paolo e Carlo, Milan, Italy.
Cerebellum. 2019 Jun;18(3):527-535. doi: 10.1007/s12311-019-01020-w.
Phantom limb pain (PLP) is a disabling and intractable sensation arising in about 80% of patients after amputation. The aim of this study was to evaluate the possibility to modulate nociceptive processing and pain perception with cerebellar transcranial direct current stimulation (ctDCS) in patients suffering from painful and non-painful phantom limb sensations. Fourteen upper limb amputees underwent ctDCS (anodal or sham, 2.0 mA, 20 min per day, 5 days a week). Clinical scores and electrophysiological parameters were assessed before tDCS, at the end of the 5-day treatment, 2 and 4 weeks later. Laser-evoked potentials (LEPs) were obtained from the stump using a Nd:YAP laser by pulses with short duration (5 ms) and small diameter spots (5 mm). Changes in visual analogue scores (VAS) were evaluated (chronic pain, paroxysmal pain, stump pain, phantom movements, phantom sensations). Anodal polarization significantly dampened LEP amplitudes (N1, p = 0.021 and N2/P2, p = 0.0034), whereas sham intervention left them unchanged. Anodal ctDCS significantly reduced paroxysmal pain (p < 0.0001), non-painful phantom limb sensations (p < 0.0001) and phantom limb movements (p = 0.0003), whereas phantom limb and stump pain did not change compared to the sham condition. Anodal ctDCS significantly improves both paroxysmal pain and non-painful phantom limb sensations, which are likely induced by maladaptive changes in the sensorimotor network and posterior parietal cortex respectively.
幻肢痛（PLP）是一种致残性和顽固性感觉，约 80%的截肢患者会出现这种感觉。本研究旨在评估小脑经颅直流电刺激（ctDCS）是否能调节疼痛处理和疼痛感知，以治疗有疼痛和无疼痛幻肢感觉的患者。14 名上肢截肢患者接受了 ctDCS（阳极或假刺激，2.0 mA，每天 20 分钟，每周 5 天）。在 tDCS 之前、5 天治疗结束时、2 周和 4 周后评估临床评分和电生理参数。使用 Nd:YAP 激光通过短持续时间（5 ms）和小直径光斑（5 mm）的脉冲从残肢获得激光诱发电位（LEP）。评估视觉模拟评分（VAS）的变化（慢性疼痛、阵发性疼痛、残肢疼痛、幻肢运动、幻肢感觉）。阳极极化显著降低 LEP 振幅（N1，p=0.021 和 N2/P2，p=0.0034），而假刺激则保持不变。阳极 ctDCS 显著降低阵发性疼痛（p<0.0001）、无痛幻肢感觉（p<0.0001）和幻肢运动（p=0.0003），而与假刺激相比，幻肢和残肢疼痛没有变化。阳极 ctDCS 显著改善阵发性疼痛和无痛幻肢感觉，这可能分别是由于感觉运动网络和后顶叶皮层的适应性变化引起的。
