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標題: | 脈衝式射頻電刺激之止痛機轉研究:大鼠軀體感覺皮層(SI)電生理量測 Electrophysiological Study in Rats' Somatosensory Cortex (SI) of Analgesic Mechanism of Pulsed-Radiofrequency Stimulation |
作者: | Yi-Ting Tsai 蔡宜庭 |
指導教授: | 林啟萬(Chii-Wann Lin) |
關鍵字: | 脈衝式射頻電刺激,止痛機轉,大腦皮層軀體感覺區SI,誘發電位, pulsed radiofrequency,analgesic mechanisms,primary somatosensory cortex(SI),evoked potential, |
出版年 : | 2014 |
學位: | 碩士 |
摘要: | 慢性疼痛是現代人普遍的困擾,每年耗費龐大的醫療資源。神經調控治療方式如脊椎神經電刺激術、周邊神經電刺激等,為常規治療失效時,重要的治療方法。其中植入式脈衝產生器廣泛應用於慢性疼痛的治療,利用輸出低頻刺激訊號於目標神經,干擾疼痛訊號的傳遞;而近年來發展的脈衝式射頻電刺激(PRF)屬於高頻刺激,對病人不會造成不適(paraesthesia)。高頻率脈衝式射頻電刺激針對慢性疼痛的治療,能夠產生良好的鎮痛效果,且對人體較無副作用、不適感低,因此在近年來被廣泛發展。高頻電刺激系統目前已知其止痛療效,但對於止痛機轉始終不明確,我們需要瞭解高頻電刺激對疼痛的抑制情形及其複雜的感覺傳遞,綜合資訊以推斷高頻脈衝電刺激之止痛機轉。根據文獻回顧歸納高頻電刺激止痛機轉假說及疼痛訊息傳遞路徑,參考先前電生理研究於脊髓區段的研究,希望更進一步了解疼痛在大腦的感知情形,於PRF電刺激後所產生的變化影響。藉由多年發展已臻成熟的電生理架構進行驗證,穩定的系統可排除多餘的不確定性,記錄不同位置的電生理訊號傳遞,不僅可達成高頻電刺激治療原理及療效的再次驗證,同時可得電生理訊號止痛成果的客觀定量記錄,亦有利於往後PRF電刺激治療後電生理的長期追蹤記錄。
本研究使用皮下電刺激及雷射熱痛刺激誘發反應,於大腦初級軀體感覺皮層(SI)進行局部場電位的記錄,實驗記錄之峰值包括皮下電刺激誘發的第一個峰(Electrical-evoked potential, EEP),以及雷射熱痛刺激誘發的兩個峰(Laser- evoked potential, LEP)LEP1、LEP2,研究分析時根據其時間推估分別將EEP假設為Aβ纖維,LEP1假設為Aδ纖維,LEP2假設為C纖維訊號。實驗之結果顯示EEP及LEP2之峰值及峰下面積皆於PRF電刺激之前後具有顯著的差異,EEP及LEP2在PRF治療後其振幅都顯著下降。這是一個令人振奮的結果,證實PRF治療在大腦皮層疼痛感知的區段,對於主導慢性疼痛的C纖維神經的傳遞仍有明顯的抑制,也讓我們對於PRF止痛的路徑能夠有更深一層的參考依據。 Chronic pain is a common problem with people nowadays, consuming huge medical resources every year. Neuromodulation treatments such as spinal cord stimulation (SCS), peripheral nerve stimulation (PNS), etc., are important methods of treatment while conventional therapies were failure. Implantable pulse generator (IPG) which is widely used among chronic pain, generate low frequency pulsed signals to stimulate spinal cord to interfere with transmission of pain signals. Pulsed radiofrequency (PRF), which is developed in recent years, is a high frequency stimulation method that would not cause paraesthesia to patients. High-frequency RF pulsed stimulation treatment has widely used in chronic pain with great analgesic effect, causing lower paraesthesia and without side effects on human body. PRF has been reported to be an effective treatment of chronic pain. However the mechanism of the analgesic action is not well known. The ‘‘pain pathway’’ is a more complex sensory nerve transmission than mere relaying of sensory information from nociceptor to brain. In order to understand the extent of pain inhibition, validation method which is able to provide supplementary information to deduce the analgesia mechanisms of PRF stimulation needs to be designed. According to the literature review, we summarize the hypotheses of analgesia mechanisms of high frequency stimulation. Refer to the previous electrophysiological studies on the spinal cord level, we further to learn more about the perception of pain of the brain cortex (SI) after PRF treatments. In this study, electrical and laser stimuli are applied to induce evoked local field potentials in the brain primary somatosensory cortex (SI). In electrophysiological recordings, there are the first peak of subcutaneous electrical-evoked potential (EEP), and the two peaks of laser- evoked potential (LEP) LEP1, LEP2. Following statistical analysis, our data suggest that the first peak of EEP corresponded to the activation of the Aβ fiber, the LEP1 and LEP2 related to Aδ and C fiber activation, relatively. The experimental results show that the peak-to-peak and root mean square values of EEP and LEP2 are both significantly decreased after the PRF treatments. This is an exciting result that prove the PRF treatments for C fiber related to chronic pain are still significantly inhibited of pain perception in the cerebral cortex, we can get more information of analgesic mechanisms and pathways about PRF stimulation. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/18427 |
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