【摘要】：理論及臨床研究均表明經(jīng)皮神經(jīng)電刺激(TENS)具有鎮(zhèn)痛作用。上世紀(jì)70年代,TENS開(kāi)始應(yīng)用于臨床,并在很多臨床疼痛治療中取得了良好的療效。如TENS在緩解術(shù)后痛、慢性疼痛、女性痛經(jīng)和分娩痛以及其他疼痛性疾病上均發(fā)揮了重要作用。TENS的鎮(zhèn)痛效果受到眾多自身及其他外界因素的影響。很多研究證明了TENS電極的安放位置、脈沖參數(shù)(包括電流強(qiáng)度、電流頻率、脈寬、治療時(shí)間及使用頻率)、個(gè)體差異等都會(huì)影響TENS的鎮(zhèn)痛效果。除了上述影響因素外,研究者們發(fā)現(xiàn)將不同脈沖參數(shù)的電針刺激(均引發(fā)痛覺(jué))結(jié)合可以起到更好的鎮(zhèn)痛效果,并且結(jié)合的方式不同,鎮(zhèn)痛效果也有差異。本研究的實(shí)驗(yàn)一首次將觸覺(jué)刺激和痛覺(jué)刺激以兩種不同的方式結(jié)合起來(lái),探討這兩種結(jié)合方式在鎮(zhèn)痛效果上的差異。另外,當(dāng)感覺(jué)刺激是由自發(fā)的行為所觸發(fā)時(shí),對(duì)刺激的感知會(huì)有所減弱,這一現(xiàn)象已廣為人知。預(yù)期行為效應(yīng)的正向模型和實(shí)際感覺(jué)反饋之間的一致性可以解釋這種現(xiàn)象。特別地,運(yùn)動(dòng)過(guò)程和觸覺(jué)感知之間的連接所引發(fā)的大腦狀態(tài)可以通過(guò)自上而下的控制來(lái)選通傷害性信息,從而起到抑制功能。因?yàn)榇竽X狀態(tài)能隨意影響對(duì)隨后不同感覺(jué)模態(tài)刺激的感知,所以我們假設(shè)在自發(fā)的觸覺(jué)刺激之后給予傷害性刺激以及在非自發(fā)的觸覺(jué)刺激之后給予傷害性刺激,前者所誘發(fā)的疼痛要明顯低于后者。因此本研究的實(shí)驗(yàn)二將比較TENS由患者自行控制來(lái)給予刺激和由外部決定來(lái)給予刺激這兩種情況下TENS的鎮(zhèn)痛效果。實(shí)驗(yàn)一考察了以兩種方式結(jié)合的TENS的鎮(zhèn)痛效果。實(shí)驗(yàn)中4Hz和100Hz的電刺激有兩種結(jié)合方式:(1)這兩種頻率的刺激波由一對(duì)電極交替給予,形成疏密波;(2)這兩種頻率的刺激波由兩對(duì)電極同時(shí)給予,形成同時(shí)波。結(jié)果表明以這兩種方式結(jié)合的TENS的鎮(zhèn)痛效果(強(qiáng)度的減弱,不愉悅感的下降)沒(méi)有差異。實(shí)驗(yàn)結(jié)果與預(yù)期及前人研究不一致,可能的原因有本研究“以觸鎮(zhèn)痛”和“以痛鎮(zhèn)痛”的TENS的結(jié)合不同于前人“以痛鎮(zhèn)痛”和“以痛鎮(zhèn)痛”的電針刺激的結(jié)合。另外,本研究以人為實(shí)驗(yàn)對(duì)象,不同于前人以老鼠為實(shí)驗(yàn)對(duì)象;最后本研究的結(jié)果在統(tǒng)計(jì)學(xué)上沒(méi)有差異,但是從描述統(tǒng)計(jì)上來(lái)看,疏密波的鎮(zhèn)痛效果有優(yōu)于同時(shí)波的鎮(zhèn)痛效果的趨勢(shì),但是可能由于被試量比較少,這種趨勢(shì)在統(tǒng)計(jì)學(xué)上不顯著。未來(lái)研究可以增加被試進(jìn)一步對(duì)兩種結(jié)合方式的鎮(zhèn)痛效果進(jìn)行研究。實(shí)驗(yàn)二考察了被試在兩種不同的條件下(自主控制觸覺(jué)刺激/非自主控制觸覺(jué)刺激)接受相同的傷害性激光刺激所產(chǎn)生的心理物理以及神經(jīng)生理反應(yīng)。這兩種條件分別是:自發(fā)的觸覺(jué)條件(Self-initiated Tactile Sensation,STS)以及非自發(fā)的觸覺(jué)條件(Non Self-initiated Tactile Sensation,N-STS)。我們觀察到在STS條件下疼痛的強(qiáng)度和不愉悅度,以及激光誘發(fā)的腦響應(yīng)相較于N-STS條件下有了顯著的下降。除此之外,在STS條件下激光刺激開(kāi)始之前的alpha和beta響應(yīng)的大小要顯著大于N-STS條件下的響應(yīng)的大小。這些結(jié)果證實(shí)了當(dāng)被試可以按照自己的意愿選擇何時(shí)觸發(fā)觸覺(jué)刺激時(shí),那么對(duì)疼痛的感知以及與疼痛相關(guān)的腦響應(yīng)都會(huì)減弱,并且該研究利用神經(jīng)響應(yīng)來(lái)反映運(yùn)動(dòng)過(guò)程和感覺(jué)反饋之間的連接。因此,我們的研究不僅詳細(xì)闡述了我們對(duì)這樣一種根本的神經(jīng)機(jī)制的理解,即觸覺(jué)誘發(fā)鎮(zhèn)痛作用的自上而下的調(diào)節(jié)的神經(jīng)機(jī)制,而且也為如何在各種臨床應(yīng)用中更好地發(fā)揮鎮(zhèn)痛作用提供了理論依據(jù)。
[Abstract]:Theoretical and clinical studies have shown that transcutaneous electrical nerve stimulation (TENS) has analgesic effects. In the 1970s, TENS began to be used in clinic and achieved good results in many clinical pain treatments. For example, TENS has played an important role in relieving postoperative pain, chronic pain, female dysmenorrhea, labor pain and other pain diseases. Many studies have shown that the placement of TENS electrodes, pulse parameters (including current intensity, current frequency, pulse width, treatment time and frequency), and individual differences all affect the analgesic effect of TENS. The combination of electroacupuncture stimulation with impulse parameters (both triggering pain) can have better analgesic effect, and the analgesic effect is different in different ways. In the first experiment of this study, tactile stimulation and pain stimulation were combined in two different ways to explore the difference of analgesic effect between the two methods. It is well known that when stimuli are triggered by spontaneous behavior, the perception of stimuli decreases. Consistency between the forward model of expected behavioral effects and actual sensory feedback can explain this phenomenon. In particular, the connection between motor processes and tactile perception can trigger brain states from top to bottom. Because the state of the brain can arbitrarily affect perception of subsequent sensory modality stimuli, we assume that nociceptive stimuli are given after spontaneous tactile stimuli, and nociceptive stimuli are given after non-spontaneous tactile stimuli, with the former causing significant pain. The analgesic effect of TENS was compared between the patient-controlled stimulation and the externally determined stimulation. Experiment 1 examined the analgesic effect of TENS combined in two ways. The results showed that there was no difference in the analgesic effect of TENS with the combination of the two methods (the decrease of intensity, the decrease of unpleasant feeling). The experimental results were inconsistent with the expectations and previous studies, and the possible reasons were as follows. In this study, the combination of "touch analgesia" and "pain analgesia" TENS was different from the combination of "pain analgesia" and "pain analgesia" electroacupuncture stimulation. In conclusion, the analgesic effect of dense wave is superior to that of simultaneous wave, but this trend is not statistically significant because the number of subjects is relatively small. Future studies may increase the study of analgesic effect of the two combination methods. The psychophysiological and neurophysiological responses to the same noxious laser stimulation are controlled tactile stimulation/uncontrolled tactile stimulation. The two conditions are: spontaneous self-initiated Tactile Sensation (STS) and non-spontaneous tactile sensation (N-STS). In addition, the alpha and beta responses before the onset of laser stimulation in STS were significantly greater than those under N-STS. These results confirm that the subjects can respond according to the experimental data. Choosing when to trigger a tactile stimulus according to one's own preference weakens both pain perception and pain-related brain responses, and this study uses neural responses to reflect the connections between motor processes and sensory feedback. Solution, that is, the neural mechanism of top-down regulation of tactile-induced analgesia, also provides a theoretical basis for how to play a better analgesic role in various clinical applications.
【學(xué)位授予單位】：西南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：B845

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