Jayathilake Nishani Jayanika, Phan Tien Thuy, Kim Jeongsook, Lee Kyu Pil, Park Joo Min
Department of Physiology, College of Veterinary Medicine, Chungnam National University, Daejeon, Republic of Korea.
Center for Cognition and Sociality, Institute for Basic Science, Daejeon, Republic of Korea.
Exp Mol Med. 2025 Mar;57(3):501-514. doi: 10.1038/s12276-025-01409-0. Epub 2025 Mar 3.
Chronic neuropathic pain is a debilitating neuroplastic disorder that notably impacts the quality of life of millions of people worldwide. This complex condition, encompassing various manifestations, such as sciatica, diabetic neuropathy and postherpetic neuralgia, arises from nerve damage or malfunctions in pain processing pathways and involves various biological, physiological and psychological processes. Maladaptive neuroplasticity, known as central sensitization, plays a critical role in the persistence of chronic neuropathic pain. Current treatments for neuropathic pain include pharmacological interventions (for example, antidepressants and anticonvulsants), invasive procedures (for example, deep brain stimulation) and physical therapies. However, these approaches often have limitations and potential side effects. In light of these challenges, interest in noninvasive neuromodulation techniques as alternatives or complementary treatments for neuropathic pain is increasing. These methods aim to induce analgesia while reversing maladaptive plastic changes, offering potential advantages over conventional pharmacological practices and invasive methods. Recent technological advancements have spurred the exploration of noninvasive neuromodulation therapies, such as repetitive transcranial magnetic stimulation, transcranial direct current stimulation and transcranial ultrasound stimulation, as well as innovative transformations of invasive techniques into noninvasive methods at both the preclinical and clinical levels. Here this review aims to critically examine the mechanisms of maladaptive neuroplasticity in chronic neuropathic pain and evaluate the efficacy of noninvasive neuromodulation techniques in pain relief. By focusing on optimizing these techniques, we can better assess their short-term and long-term effects, refine treatment variables and ultimately improve the quality of neuropathic pain management.
慢性神经性疼痛是一种使人衰弱的神经可塑性疾病,显著影响着全球数百万人的生活质量。这种复杂的病症包括坐骨神经痛、糖尿病性神经病变和带状疱疹后神经痛等多种表现形式,它源于神经损伤或疼痛处理通路的功能障碍,涉及各种生物、生理和心理过程。被称为中枢敏化的适应性不良神经可塑性在慢性神经性疼痛的持续存在中起关键作用。目前治疗神经性疼痛的方法包括药物干预(如抗抑郁药和抗惊厥药)、侵入性手术(如深部脑刺激)和物理治疗。然而,这些方法往往存在局限性和潜在的副作用。鉴于这些挑战,作为神经性疼痛替代或补充治疗方法的非侵入性神经调节技术越来越受到关注。这些方法旨在诱导镇痛,同时逆转适应性不良的可塑性变化,与传统的药物治疗和侵入性方法相比具有潜在优势。最近的技术进步推动了对非侵入性神经调节疗法的探索,如重复经颅磁刺激、经颅直流电刺激和经颅超声刺激,以及在临床前和临床水平上将侵入性技术创新性地转变为非侵入性方法。本文旨在批判性地研究慢性神经性疼痛中适应性不良神经可塑性的机制,并评估非侵入性神经调节技术在缓解疼痛方面的疗效。通过专注于优化这些技术,我们可以更好地评估它们的短期和长期效果,优化治疗变量,并最终提高神经性疼痛管理的质量。
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