Glaser John, Reeves Scott T, Stoll William David, Epperson Thomas I, Hilbert Megan, Madan Alok, George Mark S, Borckardt Jeffrey J
*Department of Orthopedic Surgery, Medical University of South Carolina, Charleston, SC †Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC ‡Menninger Clinic and Baylor College of Medicine, Houston, TX §Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC ¶Ralph H. Johnson VAMC, Charleston SC.
Spine (Phila Pa 1976). 2016 May;41(10):835-9. doi: 10.1097/BRS.0000000000001525.
Randomized, controlled pilot trial.
The present study is the first randomized, double-blind, sham-controlled pilot clinical trial of transcranial direct current stimulation (tDCS) for pain and patient-controlled analgesia (PCA) opioid usage among patients receiving spine surgery.
Lumbar spinal surgeries are common, and while pain is often a complaint that precedes surgical intervention, the procedures themselves are associated with considerable postoperative pain lasting days to weeks. Adequate postoperative pain control is an important factor in determining recovery and new analgesic strategies are needed that can be used adjunctively to existing strategies potentially to reduce reliance on opioid analgesia. Several novel brain stimulation technologies including tDCS are beginning to demonstrate promise as treatments for a variety of pain conditions.
Twenty-seven patients undergoing lumbar spine procedures at Medical University of South Carolina were randomly assigned to receive four 20-minute sessions of real or sham tDCS during their postsurgical hospital stay. Patient-administered hydromorphone usage was tracked along with numeric rating scale pain ratings.
The effect of tDCS on the slope of the cumulative PCA curve was significant (P < 0.001) and tDCS was associated with a 23% reduction in PCA usage. In the real tDCS group a 31% reduction was observed in pain-at-its-least ratings from admission to discharge (P = 0.027), but no other changes in numeric rating scale pain ratings were significant in either group.
The present pilot trial is the first study to demonstrate an opioid sparing effect of tDCS after spine surgical procedures. Although this was a small pilot trial in a heterogeneous sample of spinal surgery patients, a moderate effect-size was observed for tDCS, suggesting that future work in this area is warranted.
随机对照试验。
本研究是首个针对接受脊柱手术患者的经颅直流电刺激（tDCS）治疗疼痛及患者自控镇痛（PCA）阿片类药物使用情况的随机、双盲、假刺激对照的临床试验。
腰椎手术很常见，虽然疼痛通常是手术干预前的常见主诉，但手术本身会导致持续数天至数周的严重术后疼痛。充分的术后疼痛控制是决定恢复情况的重要因素，需要新的镇痛策略，可与现有策略联合使用，以减少对阿片类镇痛药物的依赖。包括tDCS在内的几种新型脑刺激技术开始显示出有望用于治疗各种疼痛病症。
南卡罗来纳医科大学27名接受腰椎手术的患者在术后住院期间被随机分配接受4次每次20分钟的真刺激或假刺激tDCS。记录患者自行使用氢吗啡酮的情况以及数字评分量表的疼痛评分。
tDCS对累积PCA曲线斜率的影响显著（P<0.001），且tDCS与PCA使用量减少23%相关。在真刺激tDCS组中观察到，从入院到出院，最低疼痛评分降低了31%（P=0.027），但两组数字评分量表的其他疼痛评分变化均无显著意义。
本初步试验是首个证明脊柱手术后tDCS具有阿片类药物节省效应的研究。虽然这是一项针对脊柱手术患者异质性样本的小型初步试验，但观察到tDCS有中等效应量，表明该领域未来的研究很有必要。
2级。
