Sessions of Prolonged Continuous Theta Burst Stimulation or High-frequency 10 Hz Stimulation to Left Dorsolateral Prefrontal Cortex for 3 Days Decreased Pain Sensitivity by Modulation of the Efficacy of Conditioned Pain Modulation

JOURNAL OF PAIN

卷:20

Article

De Martino, Enrico¹  Fernandes, Ana Mercia²  Galhardoni, Ricardo^2,3,4,5  Souza, Carolina De Oliveira⁶  De Andrade, Daniel Ciampi^2,3,4,7  Graven-Nielsen, Thomas¹ 

[1] Aalborg Univ, Fac Med, Dept Hlth Sci & Technol, Ctr Neuroplast & Pain CNAP,SMI, Fredrik Bajers Vej 7D-3, DK-9220 Aalborg E, Denmark

[2] Univ Sao Paulo, Dept Neurol, LIM 62, Pain Ctr, Sao Paulo, SP, Brazil

[3] Univ Sao Paulo, Sch Med, Serv Interdisciplinary Neuromodulat SIN, Lab Neurosci LIM27, Sao Paulo, SP, Brazil

[4] Univ Sao Paulo, Sch Med, Dept & Inst Psychiat, Natl Inst Biomarkers Neuropsychiat INBioN, Sao Paulo, SP, Brazil

[5] Univ City Sao Paulo UNIOD, Sch Med, Sao Paulo, SP, Brazil

[6] Univ Sao Paulo, Sch Med, Movement Disorders Clin, Dept Neurol,Hosp Clin, Sao Paulo, SP, Brazil

[7] Inst Canc Estado Sao Paulo, Sao Paulo, SP, Brazil

关键词: Pain;    repetitive transcranial magnetic stimulation;    dorsolateral prefrontal cortex;    conditioned pain modulation;    intracortical excitability;    diffuse noxious inhibitory control;   

DOI  :  10.1016/j.jpain.2019.05.010

来源: Elsevier

【 摘 要 】

The 10 Hz repetitive transcranial magnetic stimulation (10 Hz-rTMS) to the left dorsolateral prefrontal cortex produces analgesia, probably by activating the pain modulation system. A newer rTMS paradigm, called theta burst stimulation (TBS), has been developed. Unlike 10 Hz-rTMS, prolonged continuous TBS (pcTBS) mimics endogenous theta rhythms, which can improve induction of synaptic long-term potentiation. Therefore, this study investigated whether pcTBS to the left dorsolateral prefrontal cortex reduced pain sensitivity more efficiently compared with 10 Hz-rTMS, the analgesic effects lasted beyond the stimulation period, and the reduced pain sensitivity was associated with increased efficacy of conditioned pain modulation (CPM) and/or intracortical excitability. Sixteen subjects participated in a randomized cross-over study with pcTBS and 10 Hz-rTMS. Pain thresholds to heat (HPT), cold, pressure (PPT), intracortical excitability assessment, and CPM with mechanical and heat supra-pain threshold test stimuli and the cold pressor test as conditioning were collected before (Baseline), 3 (Day3) and 4 days (Day4) after 3-day session of rTMS. HPTs and PPTs increased with 10 Hz-rTMS and pcTBS at Day3 and Day4 compared with Baseline (P=.007). Based on pooled data from pcTBS and 10 Hz-rTMS, the increased PPTs correlated with increased efficacy of CPM at Day3 (P=.008), while no correlations were found at Day4 or with the intracortical excitability. Perspective: Preliminary results of this comparative study did not show stronger pain sensitivity reduction by pcTBS compared with 10 Hz-rTMS to the L-DPFC. Both protocols maintained increased pain thresholds up to 24-hours after the last session, which were partially associated with modulation of CPM efficacy but not with the intracortical excitability changes. (C) 2019 by the American Pain Society

【 授权许可】

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