慢性痛认知与治疗的脑电信号分析

发布时间：2018-09-05 17:01

【摘要】：慢性痛发病率高、分布范围广、治疗耗时长以及不尽人意的治疗效果使得慢性痛不仅是健康问题,更是社会和经济问题。长期的痛感使得慢性痛患者大脑结构和功能发生改变进而导致各种认知功能的异常。对慢性痛发展和病理特征的理解有助于慢性痛的早期干预和有效治疗。慢性痛是大脑的一种持续痛记忆,而脑电是理解大脑的窗户。因此,应用脑电信号研究慢性痛发展中不同阶段的痛记忆特征以及认知任务下慢性痛患者的病理特征,进一步理解新的慢性痛治疗手段的机理,对慢性痛的有效治疗具有重要的临床意义。本论文致力于研究慢性痛不同发展阶段下的脑电信号特征,分析慢性痛与认知相关的病理特性,探索艾灸治疗慢性痛的效果与大脑神经活动的关系,主要开展了以下研究工作:1.通过大鼠慢性痛造模实验模拟慢性痛发展过程,采用相对功率谱和一致性方法分析在不同造模时间激光刺激下的脑电数据,比较慢性痛不同发展阶段上慢性痛大鼠和对照组大鼠在δ、θ、α、β和γ频段上的功率谱特性和一致性网络特征,提出伤害性刺激诱发的神经活动介导慢性痛发展中痛记忆的形成,发现了不同频段神经活动与慢性痛发展中痛记忆形成的对应关系。2.在理解了慢性痛发展过程的神经活动变化特征基础上,进一步研究了慢性痛患者的认知病理特征。基于小波变换和平行因子相结合的方法,比较了慢性痛患者和健康被试在体感痛刺激和非痛刺激下诱发的脑电信号的时间、频率、空间特征,分析了脑电信号诱发频率与被试年龄之间的相关性。针对oddball范式进一步比较慢性痛患者和健康被试的相位同步差异,发现了慢性痛患者认知功能异常和参与痛处理的脑区内神经活动以及脑区之间相位同步连接的增强有关,对临床上慢性痛治疗具有指导意义。3.基于s LORETA源定位分析方法,研究了临床上慢性腰背痛患者在艾灸治疗前、中、后三个阶段大脑皮层电流源密度的分布特性。以热敏反应和非热敏反应为艾灸镇痛的临床疗效标签,分别比较热敏和非热敏反应的患者在艾灸镇痛前、中、后的电流密度分布差异,发现艾灸治疗慢性痛的临床效果与大脑神经活动的调制有关,艾灸镇痛主要是对前额区、次级体感皮层和扣带区β频段神经活动进行抑制。4.针对临床上部分慢性痛患者对艾灸镇痛不具有热敏反应的现象,本文进一步利用似然同步分析和图论分析,研究了热敏和非热敏慢性痛患者的全局同步强度和网络特征差异,发现非热敏反应患者的大脑网络连接比热敏反应患者具有更好的鲁棒性,而且艾灸镇痛加强了热敏反应患者大脑中与愉悦情绪相关的网络连接。
[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, 伪, 尾 and 纬 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.
【学位授予单位】：燕山大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R402

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