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经皮神经电刺激的镇痛机制及其临床应用

汤征宇, 汪汇泉, 夏晓磊, 汤艺, 彭微微, 胡理

西南大学心理学部，认知与人格教育部重点实验室，重庆 400715；深圳大学心理与社会学院，脑功能与心理科学研究中心，深圳 518060；中国科学院心理健康重点实验室(中国科学院心理研究所)，北京 100101；中国科学院大学心理学系，北京 100049

摘要

经皮神经电刺激(transcutaneous electrical nerve stimulation, TENS)是一种非侵入式的通过电流脉冲来激活外周神经纤维的镇痛疗法，具有非药理性、安全无创伤、费用低等多方面优点，已用于临床中多种疼痛的缓解。然而，TENS的临床镇痛效果存在较大的差异，这可能是由于不同刺激参数下的TENS涉及不同的镇痛机制。为推进TENS相关的基础研究与临床应用，本文首先综述了不同类型TENS镇痛的神经生理和生化机制，进而从刺激位置、脉冲参数(电流强度、频率与脉宽)以及使用时长和使用频度等多个方面讨论了影响TENS镇痛效果的因素，并总结了TENS在临床镇痛的相关应用，包括术后痛、慢性腰背痛、分娩痛等情况下的应用。最后，为实现更好的临床镇痛效果，本文提出在TENS相关的临床应用中，应充分考虑到不同刺激参数对TENS镇痛效果的影响以及患者个体间差异所导致的TENS镇痛效果的差别，优化TENS参数设置，建立基于患者疼痛评分与TENS刺激输入之间的动态关系模型，自适应地根据患者实时疼痛评分调整TENS刺激模式。

关键词： 经皮神经电刺激; 镇痛; 闸门控制理论; 弥漫性伤害抑制控制; 个性化参数设置

分类号：Q424

[Mechanisms and applications of transcutaneous electrical nerve stimulation in analgesia.] [Article in Chinese]

TANG Zheng-Yu, WANG Hui-Quan, XIA Xiao-Lei, TANG Yi, PENG Wei-Wei, HU Li

1Key Laboratory of Cognition and Personality (Ministry of Education), School of Psychology, Southwest University, Chongqing 400715, China； Brain Function and Psychological Science Research Center, College of Psychology and Sociology, Shenzhen University, Shenzhen 518060, China； The Key Laboratory of Mental Health, Institute of Psychology, the Chinese Academy of Sciences, Beijing 100101, China； Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China

Abstract

Transcutaneous electrical nerve stimulation (TENS), as a non-pharmacological and non-invasive analgesic therapy with low-cost, has been widely used to relieve pain in various clinical applications, by delivering current pulses to the skin area to activate the peripheral nerve fibers. Nevertheless, analgesia induced by TENS varied in the clinical practice, which could be caused by the fact that TENS with different stimulus parameters has different biological mechanisms in relieving pain. Therefore, to advance our understanding of TENS in various basic and clinical studies, we discussed (1) neurophysiological and biochemical mechanisms of TENS- induced analgesia; (2) relevant factors that may influence analgesic effects of TENS from the perspectives of stimulus parameters, including stimulated position, pulse parameters (current intensity, frequency, and pulse width), stimulus duration and used times in each day; and (3) applications of TENS in relieving clinical pain, including post-operative pain, chronic low back pain and labor pain. Finally, we propose that TENS may involve multiple and complex psychological neurophysiological mechanisms, and suggest that different analgesic effects of TENS with different stimulus parameters should be taken into consideration in clinical applications. In addition, to optimize analgesic effect, we recommend that individual-based TENS stimulation parameters should be designed by considering individual differences among patients, e.g., adaptively adjusting the stimulation parameters based on the dynamic ratings of patients’ pain.

Key words: transcutaneous electrical nerve stimulation; analgesia; gate control theory; diffuse noxious inhibitory control; individual-based TENS parameters

收稿日期：2016-11-09　　录用日期：2017-02-07

通讯作者：彭微微　　E-mail: ww.peng0923@gmail.com

引用本文：

汤征宇, 汪汇泉, 夏晓磊, 汤艺, 彭微微, 胡理. 经皮神经电刺激的镇痛机制及其临床应用[J]. 生理学报 2017; 69 (3): 325-334.

TANG Zheng-Yu, WANG Hui-Quan, XIA Xiao-Lei, TANG Yi, PENG Wei-Wei, HU Li. [Mechanisms and applications of transcutaneous electrical nerve stimulation in analgesia.] [Article in Chinese]. Acta Physiol Sin 2017; 69 (3): 325-334 (in Chinese with English abstract).