請用此 Handle URI 來引用此文件:
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/18427
完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 林啟萬(Chii-Wann Lin) | |
dc.contributor.author | Yi-Ting Tsai | en |
dc.contributor.author | 蔡宜庭 | zh_TW |
dc.date.accessioned | 2021-06-08T01:04:41Z | - |
dc.date.copyright | 2019-03-22 | |
dc.date.issued | 2014 | |
dc.date.submitted | 2014-08-20 | |
dc.identifier.citation | [1] N. H. Chua, K. C. Vissers, and M. E. Sluijter, 'Pulsed radiofrequency treatment in interventional pain management: mechanisms and potential indications-a review,' Acta Neurochir (Wien), vol. 153, pp. 763-71, Apr 2011.
[2] '<Neuropathic Pain Model, Spinal Nerve Ligation Model 1303~1305.pdf>.' [3] E. Goldstein, Sensation and perception: Cengage Learning, 2013. [4] J. N. Campbell and R. A. Meyer, 'Mechanisms of Neuropathic Pain,' Neuron, vol. 52, pp. 77-92, 10/5/ 2006. [5] B. Linderoth and B. A. Meyerson, 'Spinal Cord Stimulation: Exploration of the Physiological Basis of a Widely Used Therapy,' Anesthesiology, vol. 113, pp. 1265-1267 10.1097/ALN.0b013e3181fcf590, 2010. [6] D. Hegarty, 'Spinal cord stimulation: the clinical application of new technology,' Anesthesiol Res Pract, vol. 2012, p. 375691, 2012. [7] K. Kumar, R. S. Taylor, L. Jacques, S. Eldabe, M. Meglio, J. Molet, et al., 'Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomised controlled trial in patients with failed back surgery syndrome,' Pain, vol. 132, pp. 179-88, Nov 2007. [8] B. Hershey, C. Valencia, and T. L. Yearwood, 'Pulse width programming in spinal cord stimulation: a clinical study,' Pain Physician, vol. 13, pp. 321-335, 2010. [9] D. Byrd and S. Mackey, 'Pulsed radiofrequency for chronic pain,' Current Pain and Headache Reports, vol. 12, pp. 37-41, 2008/02/01 2008. [10] Y. Guan, P. W. Wacnik, F. Yang, A. F. Carteret, C.-Y. Chung, R. A. Meyer, et al., 'Spinal Cord Stimulation-induced Analgesia: Electrical Stimulation of Dorsal Column and Dorsal Roots Attenuates Dorsal Horn Neuronal Excitability in Neuropathic Rats,' Anesthesiology, vol. 113, pp. 1392-1405 10.1097/ALN.0b013e3181fcd95c, 2010. [11] M. Costigan, J. Scholz, and C. J. Woolf, 'Neuropathic pain: a maladaptive response of the nervous system to damage,' Annu Rev Neurosci, vol. 32, pp. 1-32, 2009. [12] S. A. Shankarappa, J. H. Tsui, K. N. Kim, G. Reznor, J. C. Dohlman, R. Langer, et al., 'Prolonged nerve blockade delays the onset of neuropathic pain,' Proc Natl Acad Sci U S A, vol. 109, pp. 17555-60, Oct 23 2012. [13] S. Hagiwara, H. Iwasaka, N. Takeshima, and T. Noguchi, 'Mechanisms of analgesic action of pulsed radiofrequency on adjuvant-induced pain in the rat: roles of descending adrenergic and serotonergic systems,' Eur J Pain, vol. 13, pp. 249-52, Mar 2009. [14] G. G. Xing, F. Y. Liu, X. X. Qu, J. S. Han, and Y. Wan, 'Long-term synaptic plasticity in the spinal dorsal horn and its modulation by electroacupuncture in rats with neuropathic pain,' Exp Neurol, vol. 208, pp. 323-32, Dec 2007. [15] A. Farajidavar, C. E. Hagains, Y. B. Peng, K. Behbehani, and J. C. Chiao, 'Recognition and inhibition of dorsal horn nociceptive signals within a closed-loop system,' in Engineering in Medicine and Biology Society (EMBC), 2010 Annual International Conference of the IEEE, 2010, pp. 1535-1538. [16] C. Zuo, X. Yang, Y. Wang, C. E. Hagains, A. L. Li, Y. B. Peng, et al., 'A digital wireless system for closed-loop inhibition of nociceptive signals,' J Neural Eng, vol. 9, p. 056010, Oct 2012. [17] B. Pierre, 'Applied physiology of nociception,' in Clinical Pain Management Second Edition, ed: CRC Press, 2008, pp. 3-19. [18] C. J. Woolf, 'Pain: Moving from Symptom Control toward Mechanism-Specific Pharmacologic Management,' Annals of Internal Medicine, vol. 140, pp. 441-451, 2004. [19] M. E. Sluijter and F. Imani, 'Evolution and mode of action of pulsed radiofrequency,' Anesth Pain Med, vol. 2, pp. 139-41, Spring 2013. [20] K. van Boxem, M. van Eerd, T. Brinkhuizen, J. Patijn, M. van Kleef, and J. van Zundert, 'Radiofrequency and pulsed radiofrequency treatment of chronic pain syndromes: the available evidence,' Pain Pract, vol. 8, pp. 385-93, Sep-Oct 2008. [21] T.-C. Chen, 'Electrophysiological Study of Pulsed Radiofrequency Treatment in Neuropathic Pain Model and Behavior Study of Long-term Implantation,' Institute of Biomedical Engineering, National Taiwan University, 2011. [22] W. T. Lin, C. H. Chang, C. Y. Cheng, M. C. Chen, Y. R. Wen, C. T. Lin, et al., 'Effects of low amplitude pulsed radiofrequency stimulation with different waveform in rats for neuropathic pain,' in Engineering in Medicine and Biology Society (EMBC), 2013 35th Annual International Conference of the IEEE, 2013, pp. 3590-3593. [23] D. M. Ackermann, N. Bhadra, M. Gerges, and P. J. Thomas, 'Dynamics and sensitivity analysis of high-frequency conduction block,' J Neural Eng, vol. 8, p. 065007, Dec 2011. [24] J.-H. Pan, 'An Implantable Pulsed-Radiofrequency Stimulation System with Software-defined Wireless Interface,' Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, 2013. [25] C.-H. Chang, 'Feasibility study of implantable pulsed-radiofrequency stimulator with verification on sciatica rat model,' Institute of Biomedical Engineering, National Taiwan University, 2009. [26] R. MELZACK and P. D. WALL, 'Pain Mechanisms: A New Theory,' Survey of Anesthesiology, vol. 11, pp. 89-90, 1967. [27] F. Yang, C. Y. Chung, P. W. Wacnik, A. F. Carteret, A. D. McKelvy, R. A. Meyer, et al., 'Electrical stimulation at distinct peripheral sites in spinal nerve injured rats leads to different afferent activation profiles,' Neurosci Lett, vol. 505, pp. 52-7, Nov 7 2011. [28] M. Devor, A. Carmon, and R. Frostig, 'Primary afferent and spinal sensory neurons that respond to brief pulses of intense infrared laser radiation: A preliminary survey in rats,' Experimental Neurology, vol. 76, pp. 483-494, 6// 1982. [29] F.-Z. Shaw, R.-F. Chen, H.-W. Tsao, and C.-T. Yen, 'Comparison of touch- and laser heat-evoked cortical field potentials in conscious rats,' Brain Research, vol. 824, pp. 183-196, 4/10/ 1999. [30] F.-Z. Shaw, R.-F. Chen, and C.-T. Yen, 'Dynamic changes of touch- and laser heat-evoked field potentials of primary somatosensory cortex in awake and pentobarbital-anesthetized rats,' Brain Research, vol. 911, pp. 105-115, 8/24/ 2001. [31] R.-D. Treede, J. Lorenz, and U. Baumgartner, 'Clinical usefulness of laser-evoked potentials,' Neurophysiologie Clinique/Clinical Neurophysiology, vol. 33, pp. 303-314, 2003. [32] S. Ho Kim and J. Mo Chung, 'An experimental model for peripheral neuropathy produced by segmental spinal nerve ligation in the rat,' PAIN, vol. 50, pp. 355-363, 9// 1992. [33] H. Bester, V. Chapman, J.-M. Besson, and J.-F. Bernard, Physiological Properties of the Lamina I Spinoparabrachial Neurons in the Rat vol. 83, 2000. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/18427 | - |
dc.description.abstract | 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。 | zh_TW |
dc.description.abstract | 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. | en |
dc.description.provenance | Made available in DSpace on 2021-06-08T01:04:41Z (GMT). No. of bitstreams: 1 ntu-103-R01548006-1.pdf: 2890393 bytes, checksum: 82d62b1cae8322a0190d1011334b5e86 (MD5) Previous issue date: 2014 | en |
dc.description.tableofcontents | 口試委員會審定書……………………………………………………I
目錄……………………………………………………………………II 圖表目錄………………………………………………………………V 誌謝…………………………………………………………………VIII 中文摘要………………………………………………………………IX 英文摘要………………………………………………………………X 第一章 緒論 1 1.1 研究背景 1 1.2 研究動機及目標 4 第二章 文獻回顧 6 2.1 下背痛與疼痛機轉 6 2.2 脈衝式射頻電刺激概論 9 2.3 電刺激止痛相關機轉與假說 11 2.4 痛覺傳遞與SI皮層誘發電位 14 第三章 實驗材料與方法 16 3.1實驗架構概述 16 3.2 動物準備與行為測試 17 3.2.1動物準備 17 3.2.2行為測試與觀察 17 3.2.3神經結紮疼痛模型與行為記錄 19 3.2.4 脈衝式射頻電刺激 23 3.3動物神經電生理實驗 25 3.3.1 大腦皮層SI局部場電位電生理記錄 25 3.3.2 實驗架設與分組 26 3.3.3 大鼠手術流程 28 3.3.4 神經訊號記錄與分析 35 3.3.5 灌流犧牲,切片取樣 39 3.4 數據分析 40 第四章 實驗結果 41 4.1神經病變疼痛模型及行為觀察 41 4.2 神經電生理實驗 42 4.2.1 電刺激誘發電位於SI局部場電位記錄 43 4.2.2 雷射熱痛刺激誘發電位於SI局部場電位記錄 53 4.2.3 電極紀錄點切片觀察結果 61 第五章 結果討論 62 第六章 結論與未來工作 67 6.1 結論 67 6.2 未來工作 67 參考文獻 68 | |
dc.language.iso | zh-TW | |
dc.title | 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 | zh_TW |
dc.title | Electrophysiological Study in Rats' Somatosensory Cortex (SI) of Analgesic Mechanism of Pulsed-Radiofrequency Stimulation | en |
dc.type | Thesis | |
dc.date.schoolyear | 102-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 嚴震東(Chen-Tung Yen),溫永銳(Yeong-Ray Wen),邱南福(Nan-Fu Chiu) | |
dc.subject.keyword | 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, | zh_TW |
dc.subject.keyword | pulsed radiofrequency,analgesic mechanisms,primary somatosensory cortex(SI),evoked potential, | en |
dc.relation.page | 70 | |
dc.rights.note | 未授權 | |
dc.date.accepted | 2014-08-20 | |
dc.contributor.author-college | 工學院 | zh_TW |
dc.contributor.author-dept | 醫學工程學研究所 | zh_TW |
顯示於系所單位: | 醫學工程學研究所 |
文件中的檔案:
檔案 | 大小 | 格式 | |
---|---|---|---|
ntu-103-1.pdf 目前未授權公開取用 | 2.82 MB | Adobe PDF |
系統中的文件,除了特別指名其著作權條款之外,均受到著作權保護,並且保留所有的權利。