【摘要】：慢性痛發(fā)病率高、分布范圍廣、治療耗時長以及不盡人意的治療效果使得慢性痛不僅是健康問題,更是社會和經(jīng)濟問題。長期的痛感使得慢性痛患者大腦結(jié)構(gòu)和功能發(fā)生改變進而導致各種認知功能的異常。對慢性痛發(fā)展和病理特征的理解有助于慢性痛的早期干預和有效治療。慢性痛是大腦的一種持續(xù)痛記憶,而腦電是理解大腦的窗戶。因此,應用腦電信號研究慢性痛發(fā)展中不同階段的痛記憶特征以及認知任務下慢性痛患者的病理特征,進一步理解新的慢性痛治療手段的機理,對慢性痛的有效治療具有重要的臨床意義。本論文致力于研究慢性痛不同發(fā)展階段下的腦電信號特征,分析慢性痛與認知相關的病理特性,探索艾灸治療慢性痛的效果與大腦神經(jīng)活動的關系,主要開展了以下研究工作:1.通過大鼠慢性痛造模實驗模擬慢性痛發(fā)展過程,采用相對功率譜和一致性方法分析在不同造模時間激光刺激下的腦電數(shù)據(jù),比較慢性痛不同發(fā)展階段上慢性痛大鼠和對照組大鼠在δ、θ、α、β和γ頻段上的功率譜特性和一致性網(wǎng)絡特征,提出傷害性刺激誘發(fā)的神經(jīng)活動介導慢性痛發(fā)展中痛記憶的形成,發(fā)現(xiàn)了不同頻段神經(jīng)活動與慢性痛發(fā)展中痛記憶形成的對應關系。2.在理解了慢性痛發(fā)展過程的神經(jīng)活動變化特征基礎上,進一步研究了慢性痛患者的認知病理特征�；谛〔ㄗ儞Q和平行因子相結(jié)合的方法,比較了慢性痛患者和健康被試在體感痛刺激和非痛刺激下誘發(fā)的腦電信號的時間、頻率、空間特征,分析了腦電信號誘發(fā)頻率與被試年齡之間的相關性。針對oddball范式進一步比較慢性痛患者和健康被試的相位同步差異,發(fā)現(xiàn)了慢性痛患者認知功能異常和參與痛處理的腦區(qū)內(nèi)神經(jīng)活動以及腦區(qū)之間相位同步連接的增強有關,對臨床上慢性痛治療具有指導意義。3.基于s LORETA源定位分析方法,研究了臨床上慢性腰背痛患者在艾灸治療前、中、后三個階段大腦皮層電流源密度的分布特性。以熱敏反應和非熱敏反應為艾灸鎮(zhèn)痛的臨床療效標簽,分別比較熱敏和非熱敏反應的患者在艾灸鎮(zhèn)痛前、中、后的電流密度分布差異,發(fā)現(xiàn)艾灸治療慢性痛的臨床效果與大腦神經(jīng)活動的調(diào)制有關,艾灸鎮(zhèn)痛主要是對前額區(qū)、次級體感皮層和扣帶區(qū)β頻段神經(jīng)活動進行抑制。4.針對臨床上部分慢性痛患者對艾灸鎮(zhèn)痛不具有熱敏反應的現(xiàn)象,本文進一步利用似然同步分析和圖論分析,研究了熱敏和非熱敏慢性痛患者的全局同步強度和網(wǎng)絡特征差異,發(fā)現(xiàn)非熱敏反應患者的大腦網(wǎng)絡連接比熱敏反應患者具有更好的魯棒性,而且艾灸鎮(zhèn)痛加強了熱敏反應患者大腦中與愉悅情緒相關的網(wǎng)絡連接。
[Abstract]:Chronic pain is not only a health problem, but also a social and economic problem because of its high incidence, wide distribution, long time consuming and unsatisfactory therapeutic effect. Long-term pain changes the brain structure and function of patients with chronic pain and leads to various cognitive abnormalities. Understanding the development and pathological features of chronic pain contributes to early intervention and effective treatment of chronic pain. Chronic pain is a persistent painful memory in the brain, and EEG is the window to understanding the brain. Therefore, using EEG to study the characteristics of pain memory in different stages of the development of chronic pain and the pathological characteristics of patients with chronic pain under cognitive tasks, we can further understand the mechanism of the new treatment of chronic pain. It has important clinical significance for the effective treatment of chronic pain. This paper is devoted to study the EEG characteristics of chronic pain at different stages of development, analyze the pathological characteristics of chronic pain and cognition, and explore the relationship between the effect of moxibustion on chronic pain and the neuroactivity of the brain. The following research work has been carried out: 1. The development process of chronic pain was simulated by rat chronic pain modeling experiment. The EEG data under laser stimulation at different modeling time were analyzed by relative power spectrum and consistency method. To compare the power spectrum characteristics and consistent network characteristics in 未, 胃, 偽, 尾 and 緯 bands between chronic pain rats and control rats at different stages of chronic pain, it is proposed that nociceptive stimulation-induced neural activity mediates the formation of pain memory in the development of chronic pain. The corresponding relationship between nerve activity in different frequency and pain memory formation in the development of chronic pain was found. 2. 2. On the basis of understanding the characteristics of neurologic activity in the development of chronic pain, the cognitive pathological features of patients with chronic pain were further studied. Based on the method of wavelet transform and parallel factor, the time, frequency and spatial characteristics of EEG induced by somatosensory pain stimulation and non-pain stimulation were compared between patients with chronic pain and healthy subjects. The correlation between the evoked frequency of EEG and the age of the subjects was analyzed. According to the oddball paradigm, the phase synchronization difference between patients with chronic pain and healthy subjects was further compared. It was found that the cognitive dysfunction of patients with chronic pain was related to the neural activity in the brain region involved in pain treatment and the enhancement of phase synchronous connection between the brain regions. It has guiding significance for clinical treatment of chronic pain. The distribution characteristics of cerebral cortex current source density in patients with chronic low back pain before, during and after moxibustion treatment were studied based on the method of s LORETA source localization. The clinical efficacy labels of moxibustion and analgesia were used to compare the distribution of current density before, during and after moxibustion analgesia. It was found that the clinical effect of moxibustion on chronic pain was related to the modulation of cerebral nerve activity. Moxibustion analgesia mainly inhibited 尾 -band nerve activity in prefrontal area, secondary somatosensory cortex and cingulate zone. In view of the phenomenon that some patients with chronic pain do not have a heat sensitive reaction to moxibustion analgesia in clinic, the global synchronous intensity and network characteristics of patients with chronic pain with or without heat sensitivity are studied by using likelihood synchronization analysis and graph theory analysis. It was found that the network connection of brain in patients with non-thermal reaction was more robust than that in patients with heat sensitivity, and moxibustion and analgesia enhanced the network connection related to pleasure emotion in the brain of patients with heat sensitive reaction.
【學位授予單位】：燕山大學
【學位級別】：博士
【學位授予年份】：2015
【分類號】：R402

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