摘要：

當前經顱直流電刺激(transcranial direct current stimulation, tDCS)的鎮(zhèn)痛效果不佳且存在較大的個體差異, 可能與疼痛神經網絡的復雜性及當前tDCS調控靶點單一有關。為提高tDCS緩解疼痛的效果, 本研究使用雙盲、隨機對照的實驗設計, 采用雙靶點tDCS技術, 對背外側前額葉皮層(dorsolateral prefrontal cortex, DLPFC)和初級運動皮層(primary motor cortex, M1)進行同步刺激, 通過調節(jié)DLPFC和M1所屬不同的疼痛傳導通路, 探究雙靶點tDCS的鎮(zhèn)痛效果及優(yōu)勢。 結果表明, 與假刺激對照組相比, 雙靶點tDCS組對中等強度短時熱痛、辣椒素誘發(fā)的持續(xù)性疼痛以及壓痛閾限具有顯著的調控效應, 且調控效應優(yōu)于單靶點tDCS組。同時, 雙靶點tDCS的鎮(zhèn)痛效應與被試的疼痛恐懼特質顯著相關, 即被試疼痛恐懼量表評分越高, 鎮(zhèn)痛效果越好。綜上, 本研究揭示了雙靶點tDCS對短時熱痛和持續(xù)性疼痛的穩(wěn)定鎮(zhèn)痛效果, 支持了疼痛神經網絡的并行處理理論, 也為雙靶點tDCS在疼痛治療中的潛在應用提供了科學依據。

關鍵詞: 經顱直流電刺激, 雙靶點tDCS, 鎮(zhèn)痛, 背外側前額葉皮層, 初級運動皮層

Abstract:

Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technique known for its reversibility, high safety, and patient compliance. It holds promise as a potential non-pharmacological method for analgesia. Previous studies have primarily focused on applying tDCS to the dorsolateral prefrontal cortex (DLPFC) or the primary motor cortex (M1) for pain modulation. However, the analgesic effect of tDCS has shown unsatisfactory results with significant variation among individuals, possibly due to the complexity of the pain neural network and the limited targeting of previous tDCS interventions. To improve the efficacy of tDCS in pain relief, the present study used dual-target tDCS technology to simultaneously modulate the DLPFC and M1, with the aim of investigating the analgesic effects and advantages of this approach.

In Experiment 1, a total of 80 healthy participants were double-blind, randomly allocated to receive either lDLPFC+rM1-tDCS, lDLPFC-tDCS, rM1-tDCS, or Sham-tDCS. The perception of transient pain induced by thermal stimulation and pressure pain thresholds were assessed before and after tDCS application. Dual-target tDCS demonstrated a significant analgesic effect on moderate-intensity transient pain and pressure pain thresholds, surpassing the effects observed in the lDLPFC-tDCS or rM1-tDCS groups. Furthermore, we found a significant correlation between the analgesic effects of dual-target tDCS on transient pain and participants' pain fear trait. Specifically, the higher the scores on the participants' fear of pain questionnaire, the greater the analgesic effects.

In Experiment 2, a total of 26 participants double-blinded underwent three distinct intervention conditions: lDLPFC+rM1-tDCS (Dual-target), lDLPFC or rM1-tDCS (Single-target), and Sham. The sequence of these conditions was randomized, with a minimum interval of seven days between sessions. The perception of sustained pain induced by capsaicin was assessed during tDCS modulation and 30 minutes post-stimulation. During and after the tDCS modulation, the pain intensity scores in the dual-target tDCS group were significantly lower than those in the sham stimulation group and the single-target tDCS group.

Data from Experiments 1 and 2 demonstrated that dual-target tDCS exhibited a significant analgesic effect on transient pain, sustained pain, and pressure pain thresholds. This analgesic effect was superior to that observed in the single-target tDCS group, supporting the theory of multi-pathway parallel processing in the pain neural network and providing evidence for the potential application of dual-target tDCS in pain treatment.

Key words: transcranial direct current stimulation, dual-target tDCS, analgesic, dorsolateral prefrontal cortex, primary motor cortex.

中圖分類號: 

B849 R395

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