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Evidence-based practice, reasoning, and statistics 循证实践、推理和统计
Pub Date : 1998-12-01 DOI: 10.1016/S1082-3174(98)80002-0
Ike I. Eriator
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引用次数: 1
Laser-evoked potentials for assessment of nociceptive pathways in humans 激光诱发电位评估人类伤害性通路
Pub Date : 1998-12-01 DOI: 10.1016/S1082-3174(98)80005-6
Rolf-Detlef Treede , Walter Magerl , Ulf Baumgärtner
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引用次数: 15
Pain-related somatosensory-evoked potentials following CO2 laser stimulation CO2激光刺激后与疼痛相关的躯体感觉诱发电位
Pub Date : 1998-12-01 DOI: 10.1016/S1082-3174(98)80003-2
Ryusuke Kakigi, Shoko Watanabe
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引用次数: 8
Postherpetic neuralgia Postherpetic神经痛
Pub Date : 1998-12-01 DOI: 10.1016/S1082-3174(98)80013-5
Ralf Baron
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引用次数: 7
Laser-evoked potentials in human pain 人类疼痛的激光诱发电位
Pub Date : 1998-12-01 DOI: 10.1016/S1082-3174(98)70001-7
Andrew C.N. Chen , Lars Arendt-Nielsen , Leon Plaghki

In Part I, this Focus article describes characteristics of laser-evoked brain potentials (LEPs) in human pain and examines some of the methodological inconsistencies. Evidence both cautioning and supporting the use of LEPs is contrasted. A host of neurological mechanisms clearly illustrates the relation of LEPs and pain processing: Lasers elicit selectively the cutaneous receptors of thin afferent fibers, the anterolateral spinal tract, and the lateral tracts of the brainstem. Implication for clinical use is briefly suggested. We raise three contending issues: (1) measurement standard, (2) association and dissociation of the LEP amplitude and pain, and (3) dynamic spatiotemporal specificity of LEPs. We conclude that LEPs may reflect nociceptive processing but may not be the entire pain experience. We emphasize the proper use of LEPs in understanding the mechanisms of nociceptive activation in pain experience. To achieve this, we address the technological advance required in studying the dynamic spatiotemporal specificity of LEPs and human pain.

在第一部分中,这篇Focus文章描述了人类疼痛中激光诱发脑电位(LEPs)的特征,并检查了一些方法上的不一致。对警告和支持使用lep的证据进行了对比。许多神经机制清楚地说明了lep和疼痛处理的关系:激光选择性地激发薄传入纤维的皮肤受体、脊髓前外侧束和脑干外侧束。并对其临床应用意义作了简要介绍。我们提出了三个有争议的问题:(1)测量标准;(2)LEP振幅与疼痛的关联和分离;(3)LEP的动态时空特异性。我们的结论是,lep可能反映了伤害性加工,但可能不是整个疼痛体验。我们强调lep在理解疼痛体验中伤害性激活机制中的正确使用。为了实现这一目标,我们解决了研究lep和人类疼痛的动态时空特异性所需的技术进步。
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引用次数: 46
Understanding of cerebral processing of human pain (II) by source modeling of laser-evoked potentials in conjunction with neuroimaging 通过结合神经成像的激光诱发电位源建模了解人类疼痛的大脑加工(II)
Pub Date : 1998-12-01 DOI: 10.1016/S1082-3174(98)80009-3
Andrew C.N. Chen , Lars Arendt-Nielsen , Leon Plaghki

Our current positions (Focus articles I and II) regarding the cerebral processing of human pain in the research of LEPs are the following:

  • 1.

    Discrete, repeated sensory stimulation in evoked potential research, including laser stimulation in LEPs, is not a usual, natural experience, but an artificial convenience for probing into the window of human brain function.

  • 2.

    LEP methodology requires fundamental standardization.

  • 3.

    LEPs largely reflected neural pathways associated with some aspects of nociceptive processing (the LEPs focused on are those arising from activation of A-δ fibers).

  • 4.

    LEPs, in some circumstances, may dissociate from pain perception.

  • 5.

    Absence of evidence is not evidence of absence. Some neural events (eg, silent generators) and other biophysical constraints (eg, scalp smearing of cortical potentials) can occur. Consequently, no detectable trace of neural activity as ensured in the cortex or at the scalp. Thus, LEPs can never be used to validate the absence of nociception/pain in a person.

  • 6.

    Conversely, non-nociceptive events can influence some aspects of LEPs. Thus, interpretation of LEPs demands full control and understanding of the experimental conditions.

  • 7.

    LEPs attributes are likely to reflect the sensory—discriminatory dimension, but are not sufficient for equating the full multidimensional aspects of human pain.

  • 8.

    The pain experience can be correlated with changes of the amplitudes/latencies in LEPs; but it is not true to state that pain can be inversely inferred from the parameters of the LEPs since other nonpain-related factors can also, simultaneously, affect the LEPs.

  • 9.

    Exploration of the nociceptive processing using LEPs requires quantification of the temporospatial dynamics of the topographic brain activities.

  • 10.

    The precision of measuring the brain topography associated with human pain requires high-resolution EEG (>64 channel), based on the spatial sampling principle (the shallow generators and refined small focal activation demand higher density of electrode arrays than the deep generators; detection of tangent generators demand different assumptions than the radial generators).

  • 11.

    Equivalent current dipole modeling is useful, it can be approximated by the spherical model, but requires the realistic epilloid head model coregistered with MRI for concise analysis.

  • 12.

    Without proper MRI coregistration, the isolated dipole parameters should be reported in the coordinate terms only, and not anatomic attribution.

关于LEPs研究中人类疼痛的大脑加工,我们目前的立场(焦点文章I和II)如下:1。诱发电位研究中离散的、重复的感觉刺激,包括对lep的激光刺激,并不是一种通常的、自然的体验,而是一种人为的便利,以探索人类大脑功能的窗口。LEP方法需要基本的标准化。lep在很大程度上反映了与伤害性加工的某些方面相关的神经通路(重点关注的lep是由A-δ纤维激活引起的)。在某些情况下,lep可能与疼痛感知分离。没有证据不等于没有证据。可能发生一些神经事件(如无声发生器)和其他生物物理限制(如头皮皮层电位的涂抹)。因此,在皮层或头皮上没有可检测到的神经活动痕迹。因此,lep永远不能被用来证实一个人没有伤害感觉/疼痛。相反,非伤害性事件可以影响lep的某些方面。因此,解释lep需要完全控制和理解实验条件。lep的属性可能反映了感觉上的区别,但不足以等同于人类疼痛的全部多维方面。疼痛体验可与lep振幅/潜伏期的变化相关;但是说疼痛可以从LEPs的参数反向推断是不正确的,因为其他与疼痛无关的因素也可以同时影响LEPs。利用lep探索伤害性加工需要对地形脑活动的时空动态进行量化。测量与人类疼痛相关的大脑地形的精度需要基于空间采样原理的高分辨率EEG (&gt;64通道)(浅层发生器和精细的小焦点激活比深层发生器需要更高的电极阵列密度;正切发生器的检测需要与径向发生器不同的假设)。等效电流偶极子模型是有用的,它可以用球形模型近似,但需要与MRI共同注册的真实的epilloid头部模型进行简明分析。如果没有正确的MRI共配准,孤立的偶极子参数只能在坐标项中报告,而不能在解剖归因中报告。个体的源定位可以通过个体MRI大脑的共配准来建模。为了科学的通用性,该组结果可与talairach归一化标准脑的MRI共同登记。源模型的最终验证依赖于与头皮地形研究相结合的直接颅内记录。对lep颅内记录活动的推断需要严格的规则。与PET/fMRI的血流动力学神经成像相比,了解lep脑处理的生物物理基础对于解释它们的功能关系至关重要。脑电/脑磁图(高时间分辨率,但低空间分辨率)反映了初级神经元的激活,随后(2秒到几分钟)通过PET/fMRI神经成像(低时间分辨率,但高空间分辨率)作为次级血流动力学反应。然而,这些神经和血流动力学活动可以相互影响,19.3 - 4d量化是测量和分析人脑功能的神经生理和血流动力学过程所必需的。疼痛永远无法在大脑中直接测量,但可以在严格的逻辑约束下从大脑活动中推断出来。从临床角度来看,lep可归纳为以下几个方面:1。诱发脑电位的出现表明,外围感觉冲动模式已通过特定传入系统的激活传递到大脑。诱发反应的特异性主要取决于所研究传入系统的刺激的特异性。在正常条件下,CO2激光诱导的热痛觉通路的特异性已经得到了很好的证明。因此,在疑似热痛觉通路病变的患者中获得lep有以下几个原因:(a)客观地确认感觉功能障碍或缺陷的存在,(b)寻找功能障碍的潜在机制,(c)检测亚临床异常,(d)监测其演变,(e)评估治疗干预的效果。lep已被成功地应用于各种神经病理条件,其中传统的电诱发电位被证明是无效的或不合适的,如小纤维神经病、神经根病、脊髓病、脑干病变、中枢性疼痛综合征和痛觉过敏状态。
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引用次数: 1
What do pain-evoked potentials really measure? Revisited 疼痛诱发电位真正测量的是什么?重新审视
Pub Date : 1998-12-01 DOI: 10.1016/S1082-3174(98)80004-4
Ruth Zaslansky, Elliot Sprecher, David Yarnitsky
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引用次数: 4
Cerebral sources of laser-evoked potentials 激光诱发电位的大脑来源
Pub Date : 1998-12-01 DOI: 10.1016/S1082-3174(98)80007-X
Jürgen Lorenz
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引用次数: 1
Neuropathic pain 神经性疼痛
Pub Date : 1998-12-01 DOI: 10.1016/S1082-3174(98)80011-1
David Yarnitsky , Elon Eisenberg
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引用次数: 17
Is postherpetic neuralgia more than one disorder? 带状疱疹后神经痛不止一种疾病吗?
Pub Date : 1998-12-01 DOI: 10.1016/S1082-3174(98)70003-0
Michael C. Rowbotham , Karin Lottrup Petersen , Howard L. Fields

Acute herpes zoster is a highly stereotyped condition of viral recrudescence producing inflammation in a dorsal root ganglion, a segmental vesicular rash, and pain. The long-term outcome is unpredictable. Those acute zoster patients that develop postherpetic neuralgia (PHN) fall into three subtypes: (1) an “irritable nociceptor” group with minimal deafferentation and touch-evoked allodynia due to peripheral nociceptor input, (2) a deafferentation group with marked sensory loss and no allodynia, and (3) a deafferentation group with sensory loss and allodynia due to central reorganization. Response to therapy also shows significant inhomogeneity. Some patients obtain nearly complete relief by either topical agents or oral monotherapy with opioids, antidepressants, or anticonvulsants. Other PHN sufferers are refractory to all measures, similar to patients with spinal cord injury and central poststroke pain. Because the clinical picture of PHN falls into distinct patterns based on differing pathophysiology, PHN should be thought of as several disorders, which may respond differently to therapeutic interventions and which may or may not coexist in the same patient.

急性带状疱疹是一种高度定型的疾病,病毒复发产生背根神经节炎症,节段性水疱疹和疼痛。长期的结果是不可预测的。发生带状疱疹后神经痛(PHN)的急性带状疱疹患者可分为三种亚型:(1)“激惹性伤害感受器”组,由于外周伤害感受器输入,有轻微的神经传递障碍和触摸诱发的异常痛觉;(2)神经传递障碍组,有明显的感觉丧失和无异常痛觉;(3)神经传递障碍组,由于中枢重组,有感觉丧失和异常痛觉。对治疗的反应也表现出明显的不均匀性。一些患者通过局部用药或口服阿片类药物、抗抑郁药或抗惊厥药的单药治疗获得几乎完全的缓解。其他PHN患者与脊髓损伤和中枢性中风后疼痛的患者类似,对所有措施都难以治疗。由于PHN的临床表现基于不同的病理生理学而呈现出不同的模式,因此应将PHN视为几种疾病,这些疾病对治疗干预的反应可能不同,并且可能在同一患者中共存,也可能不共存。
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引用次数: 60
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Pain Forum
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