Clinica Neurologica, Dipartimento di Neuroscienze, Università Tor Vergata, Rome, Italy.
J Pain. 2010 May;11(5):436-42. doi: 10.1016/j.jpain.2009.08.011. Epub 2009 Dec 16.
UNLABELLED: Neuropathic pain in patients with MS is frequent and is associated with a great interference with daily life activities. In the present study, we investigated whether anodal transcranial direct current stimulation (tDCS) may be effective in reducing central chronic pain in MS patients. Patients received sham tDCS or real tDCS in a 5-day period of treatment in a randomized, double blind, sham-controlled study. Pain was measured using visual analog scale (VAS) for pain and the short form McGill questionnaire (SF-MPQ). Quality of life was measured using the Multiple Sclerosis Quality of Life-54 scale (MSQoL-54). Depressive symptoms and anxiety were also evaluated as confounding factors using the Beck Depression Inventory (BDI) and VAS for anxiety. Evaluations were performed at baseline, immediately after the end of treatment, and once a week during a 3-week follow-up period. Following anodal but not sham tDCS over the motor cortex, there was a significant pain improvement as assessed by VAS for pain and McGill questionnaire, and of overall quality of life. No depression or anxiety changes were observed. Our results show that anodal tDCS is able to reduce pain-scale scores in MS patients with central chronic pain and that this effect outlasts the period of stimulation, leading to long-lasting clinical effects. PERSPECTIVE: This article presents a new, noninvasive therapeutic approach to chronic, central neuropathic pain in multiple sclerosis, poorly responsive to current conventional medications. tDCS is known to cause long-lasting changes of neuronal excitability at the site of stimulation and in the connected areas in healthy subjects. This led us to hypothesize that pain decrease may be the result of functional plastic changes in brain structures involved in the pathogenesis of chronic neuropathic pain.
背景:多发性硬化症(MS)患者常出现神经病理性疼痛,这极大地干扰了他们的日常生活活动。在本研究中,我们旨在探讨经颅直流电刺激(tDCS)是否能有效减轻 MS 患者的中枢性慢性疼痛。在一项随机、双盲、假刺激对照研究中,患者在 5 天的治疗期内接受假 tDCS 或真 tDCS。采用视觉模拟评分(VAS)和麦吉尔疼痛问卷(SF-MPQ)评估疼痛,采用多发性硬化生活质量量表-54 项(MSQoL-54)评估生活质量。采用贝克抑郁量表(BDI)和 VAS 评估抑郁和焦虑作为混杂因素。基线、治疗结束后即刻和治疗结束后 3 周内每周进行评估。与假刺激相比,经颅直流电刺激运动皮质后,疼痛 VAS 评分和麦吉尔问卷评分均显著改善,整体生活质量也得到改善。未观察到抑郁或焦虑的变化。
结论:与假刺激相比,经颅直流电刺激运动皮质能减轻 MS 中枢性慢性疼痛患者的疼痛评分,且这种效果持续时间长,具有长期的临床效果。
观点:本文提出了一种新的、非侵入性的治疗方法,用于治疗对现有常规药物反应不佳的多发性硬化症的中枢性慢性神经病理性疼痛。在健康受试者中,tDCS 已知能引起刺激部位和连接区域神经元兴奋性的长期变化。这使我们假设疼痛减轻可能是参与慢性神经病理性疼痛发病机制的脑结构功能可塑性变化的结果。
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