| Background: neuropathic pain occurs after total brachial plexus avulsion,and most drugs and surgical treatments are ineffective.The hypersensitization of the central nervous system and the maladaptive reorganization of cortical function caused by deafferent injury are considered to be the possible mechanisms of neuropathic pain after brachial plexus avulsion.Mirror feedback may improve the maladaptive reorganization of the corresponding cerebral cortex by activating the sensorimotor cortex,thus relieving intractable neuropathic pain after total brachial plexus injury.Objectives:to use network meta-analysis to verify the therapeutic effect of mirror feedback on this kind of pain.Brain functional imaging was used to explore the changes of volume and density of cerebral cortex and gray matter and their relationship with pain in patients with neuropathic pain after total brachial plexus injury.Combined with the subjective pain perception,pain score,psychological questionnaire score and the changes of brain structure and function,the therapeutic effect of mirror feedback on neuropathic pain after total brachial plexus injury was evaluated.Methods: in the first part of the network meta-analysis,the literatures were screened with the key word "phantom limb pain,PLP,treatment" in Medline,Embase,Web of Science and Cochrane databases,and the data obtained were analyzed by STATA software.The therapeutic effect of existing treatments on phantom limb pain was evaluated by the value of surface area under the cumulative ranking curve(SURCA)of each intervention.The second part included 28 subjects with pain after brachial plexus injury and 29 healthy controls.SPM12 and DPASF software were used to extract and analyze the gray matter volume data of high-resolution three-dimensional T1 structural images of the two groups,in order to understand the effect of pain on the volume of cerebral gray matter after brachial plexus injury and the correlation between them.In the third part,18 patients with pain after brachial plexus injury were treated with mirror feedback for 6 weeks.the therapeutic effect of mirror feedback on this kind of pain was comprehensively understood through the functional magnetic resonance data of left hand,right hand and both hands before and after treatment combined with pain visual score and psychological evaluation questionnaire.Results: in the first part,13 intervention measures for phantom limb pain were analyzed through network meta-analysis,and it was found that the treatment method of mirror feedback and phantom limb movement was the most effective.The second part of the study found that,compared with healthy controls,the volume of cerebral gray matter in patients with neuropathic pain after total brachial plexus injury decreased significantly in bilateral para-hippocampal gyrus,superior temporal gyrus,paracentric lobule,postcentral gyrus,precentral gyrus,middle frontal gyrus,inferior frontal gyrus,auxiliary motor cortex,middle occipital gyrus,superior parietal gyrus,cuneate lobe,right middle temporal gyrus,right inferior temporal gyrus and left cuneate gyrus.It increased in insular,pons,middle frontal gyrus,cingulate gyrus,inferior parietal lobule,bilateral thalamus and globus pallidus.Spearman correlation analysis between differential brain regions and pain scores did not find the correlation between pain scores and different brain regions.The third part found that after 6weeks of mirror feedback treatment,the subjective pain experience and pain score of the subjects were significantly improved,and no symptoms of anxiety and depression were found in psychological evaluation.In terms of brain functional imaging,the gray matter volume of superior temporal gyrus /parahippocampal gyrus / inferior frontal gyrus and auxiliary motor cortex increased significantly,and the activation of upper limb motor sensory cortex increased.Conclusion: mirror feedback therapy can be used as an effective treatment for neuropathic pain after total brachial plexus injury. |
PDF Full Text Request