Linderoth B, Stiller C O, O'Connor W T, Hammarström G, Ungerstedt U, Brodin E
Department of Neurosurgery, Karolinska Institute, Stockholm, Sweden.
Acta Neurochir Suppl (Wien). 1993;58:156-60. doi: 10.1007/978-3-7091-9297-9_36.
Electrical spinal cord stimulation (SCS) is an important method in the treatment of certain chronic pain syndromes which are difficult to manage with conventional techniques. The indications for this procedure have gradually narrowed to neuropathic pain states, especially those of peripheral origin, ischaemic pain due to peripheral vascular disease, and treatment-resistant angina pectoris. In spite of the clinical use of this method for more than 20 years, the mechanisms underlying the pain alleviating effect remain largely unknown. For the effect on ischaemic pain, recent animal research indicates a mediation via autonomic pathways. Concerning the effect on neuropathic pain progress in knowledge has been scanty. Data from spinal microdialysis in decerebrated or anaesthetized animals indicate the possible importance of serotonin and substance P in the dorsal horn for pain inhibition by SCS. However, data from experiments on anaesthetized animals are, for several reasons, not likely to truely reflect the mechanisms active in conscious humans under treatment with SCS. To avoid the influence of anaesthesia and to approach the clinical situation, we have developed an animal model enabling simultaneous SCS and supraspinal microdialysis in awake, freely moving rats. The animal model is described and some preliminary data indicating a release of gamma-amino butyric acid (GABA) induced by SCS in the periaqueductal grey matter (PAG), are presented.
脊髓电刺激(SCS)是治疗某些用传统技术难以处理的慢性疼痛综合征的重要方法。该手术的适应症已逐渐缩小到神经性疼痛状态,尤其是外周性起源的疼痛、外周血管疾病引起的缺血性疼痛以及难治性心绞痛。尽管该方法已临床应用20多年,但疼痛缓解效果的潜在机制仍 largely unknown。对于缺血性疼痛的影响,最近的动物研究表明通过自主神经通路介导。关于对神经性疼痛的影响,知识进展一直很少。来自去大脑或麻醉动物的脊髓微透析数据表明,5-羟色胺和P物质在背角对SCS抑制疼痛可能很重要。然而,由于几个原因,麻醉动物实验的数据不太可能真实反映接受SCS治疗的清醒人类中活跃的机制。为避免麻醉的影响并接近临床情况,我们开发了一种动物模型,能够在清醒、自由活动的大鼠中同时进行SCS和脊髓上微透析。描述了该动物模型,并展示了一些初步数据,表明SCS诱导中脑导水管周围灰质(PAG)释放γ-氨基丁酸(GABA)。