Optimizing Rehabilitation for Phantom Limb Pain Using Mirror Therapy and tDCS

使用镜像疗法和 tDCS 优化幻肢痛康复

基本信息

批准号：
8964447
负责人：
Felipe Fregni
金额：
$ 34.24万
依托单位：
SPAULDING REHABILITATION HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-08-01 至 2019-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8964447
关键词：
Accounting Affect Aftercare Amputees Analgesics Area Behavior Therapy Biological Neural Networks Boston Brain Caring Chronic Clinical Complex Couples Therapy Dimensions Functional Magnetic Resonance Imaging Goals Hospitals Intervention Lead Limb structure Measures Medical Membrane Methods Modeling Motor Cortex Movement Neurons Neurorehabilitation Operative Surgical Procedures Pain Patients Perception Phantom Limb Pain Physiologic pulse Quality of life Randomized Randomized Controlled Trials Rehabilitation Centers Rehabilitation therapy Reporting Research Resistance Sensory Severities Side Somatosensory Cortex Spinal cord injury Structure Syndrome Techniques Transcranial magnetic stimulation Visual analog base biopsychosocial blood oxygen level dependent chronic pain control trial cortex mapping design disability exhaust experience follow-up functional restoration indexing interdisciplinary approach neural correlate neuromechanism neuroregulation novel painful neuropathy post-amputation pain programs response tool treatment planning

项目摘要

DESCRIPTION (provided by applicant): Rehabilitation for chronic pain involves a structured treatment plan targeting all dimensions of the pain experience, and should include a comprehensive interdisciplinary approach that allows patients to receive the most benefit according to their needs. As in other chronic pain syndromes, chronic Phantom limb pain (PLP) is often difficult to treat, showing to be resistant to classical pharmacological and surgical treatment approaches. This lack of efficacy in treatment of PLP is because current rehabilitative measures do not take into account the complex underlying neural mechanisms related to this pain. In fact, extensive evidence indicates that chronic PLP is a phenomenon related to a significant reorganization of the somatosensory and motor cortex. Analgesic drugs do not counteract the mechanisms that lead to maladaptive plasticity of these areas, and therefore is not the most efficacious treatment. In this context, we hypothesize that novel treatments of PLP need to target specific neural networks associated with this maladaptive plasticity. Transcranial direct current stimulation (tDCS) is a powerful and non-invasive technique of brain stimulation that is known to significantly modulate plasticity and alleviate chronic pain in various syndromes. Recently, we showed that anodal tDCS can induce a selective short-lasting relief from PLP, and repeated applications of anodal tDCS induces long- lasting analgesic effects. These preliminary results show that tDCS may be a promising rehabilitative tool for the management of chronic PLP. Given tDCS underlying neural mechanisms, it is critical to use a multimodal approach to treatment - using both tDCS and behavioral therapy simultaneously. In this case, an ideal therapy is mirror therapy (MT). This neurorehabilitation technique is commonly used in PLP, and is designed to modulate cortical mechanisms of pain by performing movements using the unaffected limb in front of a mirror. We propose to carry out a mechanistic, factorial, randomized controlled trial to evaluate a novel rehabilitation approach combining tDCS and MT in PLP patients. We aim to compare the brain changes before and after treatment in order to study the mechanisms underlying PLP. Aim 1 will evaluate the efficacy of tDCS and MT as rehabilitative tools. Patients will be assigned to one of four groups: active tDCS/MT; sham tDCS/MT; active tDCS/sham MT (covered MT); and sham tDCS/sham MT (covered MT). Aim 2 will examine the mechanisms underlying PLP. We will use single and paired-pulse transcranial magnetic stimulation (TMS) to assess cortical mapping and cortical excitability changes associated with cortical reorganization. We will also use functional magnetic resonance imaging (fMRI) to assess brain responses in the sensory-motor cortex associated with this treatment. This proposal has a great significance as it will help to understand and develop a novel intervention for PLP. Spaulding Rehabilitation Hospital - where this proposal is being developed - is a major center for rehabilitation of amputees including most of the amputees from the Boston Marathon Bombing. RELEVANCE: Chronic phantom limb pain (PLP) is recognized as very difficult to treat as it is often resistant to classical pharmacological and surgical treatment approaches. It is a major cause of disability and a main contributor to the quality of life. Extensive evidence indicates tha PLP is a phenomenon related to significant maladaptive brain changes. In this study we propose to investigate a novel rehabilitation approach combining a behavioral therapy- mirror therapy- with a method of brain modulation (tDCS) to treat and investigate the mechanisms of PLP.

描述（由申请人提供）：慢性疼痛的康复涉及针对疼痛经历的各个方面的结构化治疗计划，并且应包括全面的跨学科方法，使患者能够根据自己的需要获得最大的益处，就像其他慢性疼痛综合征一样。慢性幻肢痛（PLP）通常难以治疗，对传统的药物和手术治疗方法具有抵抗力，PLP 治疗缺乏疗效是因为目前的康复措施没有考虑到复杂的潜在神经元。事实上，大量证据表明，慢性 PLP 是一种与体感和运动皮层显着重组相关的现象，镇痛药物不能抵消导致这些区域适应不良的机制。在这种背景下，我们追求 PLP 的新疗法需要针对与这种适应不良可塑性相关的特定神经网络，这是一种强大且有效的治疗方法。已知可显着调节可塑性并减轻各种综合症的慢性疼痛的非侵入性脑刺激技术。最近，我们发现阳极 tDCS 可以选择性地短期缓解 PLP，并且重复应用阳极 tDCS 可以产生持久的镇痛效果。这些初步结果表明，tDCS 可能是治疗慢性 PLP 的一种有前景的康复工具。鉴于 tDCS 的潜在神经机制，使用多模式行为方法进行治疗至关重要——同时使用 tDCS 和治疗。在这种情况下，理想的治疗方法是镜像疗法。 (MT)。这种神经康复技术通常用于 PLP，旨在通过在镜子前使用未受影响的肢体进行运动来调节疼痛的皮质机制。我们建议进行机械、阶乘、随机对照试验来进行评估。结合 tDCS 和 MT 治疗 PLP 患者的新型康复方法我们旨在比较治疗前后的大脑变化，以研究 PLP 的潜在机制，目标 1 将评估 tDCS 和 MT 的疗效。患者将被分配到四组之一：主动 tDCS/MT；主动 tDCS/假 MT（涵盖 MT）；以及假 tDCS/假 MT（涵盖 MT）。我们将使用单脉冲和成对脉冲经颅磁刺激 (TMS) 来评估皮质映射和与皮质相关的皮质兴奋性变化。我们还将使用功能磁共振成像（fMRI）来评估与这种治疗相关的感觉运动皮层的大脑反应，因为它将有助于理解和开发一种新型的 PLP 康复干预措施。正在制定该提案的医院是截肢者康复的主要中心，其中包括波士顿马拉松爆炸事件中的大多数截肢者。相关性：慢性幻肢痛（PLP）被认为非常难以治疗，因为它通常对经典的药物和手术治疗方法有抵抗力，它是导致残疾的主要原因，也是影响生活质量的主要因素。 PLP 是一种与显着的适应不良大脑变化相关的现象，在这项研究中，我们建议研究一种新颖的康复方法，将行为疗法（镜像疗法）与大脑调节方法 (tDCS) 结合起来，以治疗和研究 PLP 的机制。 PLP。