Cosentino Giuseppe, Antoniazzi Elisa, Cavigioli Camilla, Tang Vanessa, Tammam Giulia, Zaffina Chiara, Tassorelli Cristina, Todisco Massimiliano
Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy.
Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy.
J Clin Med. 2023 Nov 13;12(22):7066. doi: 10.3390/jcm12227066.
Offset analgesia (OA), which is defined as a disproportionately large reduction in pain perception following a small decrease in a heat stimulus, quantifies temporal aspects of endogenous pain modulation. In this study on healthy subjects, we aimed to (i) determine the Heat Pain Threshold (HPT) and the response to constant and dynamic heat stimuli assessing sensitization, adaptation and OA phenomena at the thenar eminence; (ii) evaluate the effects of high-frequency repetitive Transcranial Magnetic Stimulation (rTMS) of the primary motor cortex (M1) on these measures. Twenty-four healthy subjects underwent quantitative sensory testing before and after active or sham 10 Hz rTMS (1200 stimuli) of the left M1, during separate sessions. We did not observe any rTMS-related changes in the HPT or visual analogue scale (VAS) values recorded during the constant trial. Of note, at baseline, we did not find OA at the thenar eminence. Only after active rTMS did we detect significantly reduced VAS values during dynamic heat stimuli, indicating a delayed and attenuated OA phenomenon. rTMS of the left M1 may activate remote brain areas that belong to the descending pain modulatory and reward systems involved in the OA phenomenon. Our findings provide insights into the mechanisms by which rTMS of M1 could exert its analgesic effects.
偏倚性镇痛(OA)被定义为在热刺激稍有降低后疼痛感知的不成比例的大幅降低,它量化了内源性疼痛调节的时间方面。在这项针对健康受试者的研究中,我们旨在:(i)确定热痛阈值(HPT)以及对恒定和动态热刺激的反应,以评估鱼际肌处的敏化、适应和OA现象;(ii)评估初级运动皮层(M1)的高频重复经颅磁刺激(rTMS)对这些指标的影响。24名健康受试者在不同时段分别接受了左侧M1的10Hz主动或假刺激rTMS(1200次刺激)前后的定量感觉测试。在恒定试验期间记录的HPT或视觉模拟量表(VAS)值中,我们未观察到任何与rTMS相关的变化。值得注意的是,在基线时我们在鱼际肌处未发现OA。仅在主动rTMS后,我们才检测到在动态热刺激期间VAS值显著降低,表明OA现象延迟且减弱。左侧M1的rTMS可能激活了属于参与OA现象的下行疼痛调节和奖赏系统的远程脑区。我们的研究结果为M1的rTMS发挥其镇痛作用的机制提供了见解。