Núcleo de Neurociências, Centro de Ciências Biológicas e da Saúde, Universidade Presbiteriana Mackenzie, Sao Paulo, Brazil.
Clin J Pain. 2009 Oct;25(8):691-5. doi: 10.1097/AJP.0b013e3181af1414.
Based on evidence showing that electrical stimulation of the nervous system is an effective method to decrease chronic neurogenic pain, we aimed to investigate whether the combination of 2 methods of electrical stimulation-a method of peripheral stimulation [transcutaneous electrical nerve stimulation (TENS)] and a method of noninvasive brain stimulation [transcranial direct current stimulation (tDCS)]-induces greater pain reduction as compared with tDCS alone and sham stimulation.
We performed a preliminary, randomized, sham-controlled, crossover, clinical study in which 8 patients were randomized to receive active tDCS/active TENS ("tDCS/TENS" group), active tDCS/sham TENS ("tDCS" group), and sham tDCS/sham TENS ("sham" group) stimulation. Assessments were performed immediately before and after each condition by a blinded rater.
The results showed that there was a significant difference in pain reduction across the conditions of stimulation (P=0.006). Post hoc tests showed significant pain reduction as compared with baseline after the tDCS/TENS condition [reduction by 36.5% (+/-10.7), P=0.004] and the tDCS condition [reduction by 15.5% (+/-4.9), P=0.014], but not after sham stimulation (P=0.35). In addition, tDCS/TENS induced greater pain reduction than tDCS (P=0.02).
The results of this pilot study suggest that the combination of TENS with tDCS has a superior effect compared with tDCS alone.
有证据表明，刺激神经系统是减轻慢性神经性疼痛的有效方法，本研究旨在探讨两种电刺激方法（外周刺激[经皮神经电刺激（TENS）]和非侵入性脑刺激[经颅直流电刺激（tDCS）]）的联合应用是否比单独使用 tDCS 及假刺激能带来更大的疼痛缓解。
我们进行了一项初步的、随机的、假对照、交叉临床试验，将 8 例患者随机分为接受真 tDCS/真 TENS（“tDCS/TENS”组）、真 tDCS/假 TENS（“tDCS”组）和假 tDCS/假 TENS（“假刺激”组）刺激。由一名盲法评估者在每个条件下进行评估。
结果显示，刺激条件下的疼痛缓解存在显著差异（P=0.006）。事后检验显示，tDCS/TENS 条件下[减少 36.5%（+/-10.7），P=0.004]和 tDCS 条件下[减少 15.5%（+/-4.9），P=0.014]的疼痛较基线显著减轻，但假刺激条件下无显著减轻（P=0.35）。此外，tDCS/TENS 引起的疼痛缓解优于 tDCS（P=0.02）。
这项初步研究的结果表明，TENS 与 tDCS 的联合应用比单独使用 tDCS 具有更好的效果。
