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首页> 外文期刊>BMC Neuroscience >Cortical disinhibition occurs in chronic neuropathic, but not in chronic nociceptive pain
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Cortical disinhibition occurs in chronic neuropathic, but not in chronic nociceptive pain

机译：皮质抑制作用发生在慢性神经性疼痛中，而不发生在慢性伤害性疼痛中

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Background The aim of this study was to examine the relationship between chronic neuropathic pain after incomplete peripheral nerve lesion, chronic nociceptive pain due to osteoarthritis, and the excitability of the motor cortex assessed by transcranial magnetic stimulation (TMS). Hence in 26 patients with neuropathic pain resulting from an isolated incomplete lesion of the median or ulnar nerve (neuralgia), 20 patients with painful osteoarthritis of the hand, and 14 healthy control subjects, the excitability of the motor cortex was tested using paired-pulse TMS to assess intracortical inhibition and facilitation. These excitability parameters were compared between groups, and the relationship between excitability parameters and clinical parameters was examined. Results We found a significant reduction of intracortical inhibition in the hemisphere contralateral to the lesioned nerve in the neuralgia patients. Intracortical inhibition in the ipsilateral hemisphere of neuralgia patients and in both hemispheres of osteoarthritis patients did not significantly differ from the control group. Disinhibition was significantly more pronounced in neuralgia patients with moderate/severe pain intensity than in patients with mild pain intensity, whereas the relative compound motor action potential as a parameter of nerve injury severity did not correlate with the amount of disinhibition. Conclusions Our results suggest a close relationship between motor cortex inhibition and chronic neuropathic pain in the neuralgia patients, which is independent from nerve injury severity. The lack of cortical disinhibition in patients with painful osteoarthritis points at differences in the pathophysiological processes of different chronic pain conditions with respect to the involvement of different brain circuitry.
机译：背景技术这项研究的目的是检查不完全周围神经病变后的慢性神经性疼痛，由于骨关节炎引起的慢性伤害性疼痛以及经颅磁刺激（TMS）评估运动皮层的兴奋性之间的关系。因此，在26例由于孤立的中位或尺神经不完全病变（神经痛）引起的神经性疼痛患者，20例手部疼痛性骨关节炎患者和14例健康对照组中，使用配对脉冲测试了运动皮层的兴奋性TMS评估皮质内抑制和促进。比较各组的这些兴奋性参数，并检查兴奋性参数与临床参数之间的关系。结果我们发现神经痛患者与病变神经对侧的大脑半球皮层内抑制明显降低。在神经痛患者的同侧半球和骨关节炎患者的两个半球的皮层内抑制与对照组无显着差异。在中度/重度疼痛强度的神经痛患者中，抑制作用比轻度疼痛程度的患者明显更明显，而作为神经损伤严重程度参数的相对复合运动潜能与抑制作用量无关。结论我们的结果表明神经痛患者的运动皮层抑制与慢性神经性疼痛之间存在密切关系，而与神经损伤的严重程度无关。患有疼痛性骨关节炎的患者缺乏皮质抑制作用，这表明不同慢性疼痛状况的病理生理过程相对于不同的大脑回路的参与是不同的。

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