利多卡因贴剂治疗慢性腰痛的功能磁共振研究

Functional Magnetic Resonance Imaging Study of Lidocaine Patch in Treating Chronic Low Back Pain

摘要:

目的：基于功能磁共振成像探讨利多卡因贴剂治疗慢性腰痛(chronic low back pain, cLBP)的疗效及潜在神经机制。 方法：招募50例 cLBP患者，随机分为试验组(n=25)和对照组(n=25)。试验组和对照组分别接受2周的利多卡因凝胶贴膏和安慰剂治疗，在治疗前和治疗2周后接受临床评估及功能磁共振扫描。通过低频振幅(amplitude of low frequency fluctuations, ALFF)及功能连接(functional connectivity, FC)分析，探讨两组cLBP患者治疗前后的中枢神经活动变化。 结果：（1）试验组患者在疼痛强度改善的同时，中枢敏化和神经病理性疼痛评分也显著降低，而对照组患者仅发现疼痛强度改善。（2）与用药前相比，试验组表现出左侧小脑VIII区的ALFF降低、右侧枕叶距状裂周围皮层的ALFF增加，以及左侧小脑VIII区与右侧三角部额下回的FC降低，而对照组无显著变化。（3）临床疼痛强度（brief pain inventory, BPI）及神经病理性疼痛症状（leeds assessment of neuropathic symptoms and sign, LANSS)改善程度与左侧小脑VIII区ALFF的降低呈正相关。 结论：利多卡因贴剂治疗可以有效改善慢性腰痛的症状，其镇痛中枢机制可能部分源于对小脑、额下回功能活动的调节作用。

Abstract:

Objective: To investigate the efficacy and potential neuromechanism of lidocaine patch in treating chronic low back pain (cLBP) based on functional magnetic resonance imaging (fMRI). Method: A total of 50 patients with cLBP were recruited and randomly divided into an experimental group (n=25) and a control group (n=25). Participants in the experimental and control groups received two weeks of treatment with lidocaine gel patch versus placebo, respectively. Clinical evaluations and fMRI were conducted before treatment and after two weeks of therapy. Changes in central nervous system activity were explored through analysis of low-frequency fluctuation amplitude (ALFF) and functional connectivity (FC) before and after treatment. Results: (1) Patients in the experimental group showed significant reductions in both central sensitization and neuropathic pain scores alongside improvements in pain intensity, whereas the control group only demonstrated pain intensity reduction. (2) Compared with pre-treatment, the experimental group showed significantly decreased ALFF in the left cerebellar lobule VIII，increased ALFF in the right Calcarine，decreased FC between the left cerebellar lobule VIII and the right triangular part of inferior frotal gyrus. However, there was no significant change in the control group after treatment. (3) The improvement in clinical pain intensity (brief pain inventory, BPI) and neuropathic pain symptoms (leeds assessment of neuropathic symptoms and sign, LANSS) was positively correlated with the decrease of ALFF in the the left cerebellar lobule VIII. Conclusion: The treatment with lidocaine patch can effectively improve the symptoms of cLBP, and the central analgesic mechanisms may partially stem from the modulation of functional activities in the cerebellum and inferior frontal gyrus.