Mendonca Mariana E, Simis Marcel, Grecco Luanda C, Battistella Linamara R, Baptista Abrahão F, Fregni Felipe
Department of Neuroscience and Behavior, Institute of Psychology, University of São Paulo São Paulo, Brazil.
Physical and Rehabilitation Medicine Institute of the University of São Paulo, Medical School General Hospital São Paulo, Brazil.
Front Hum Neurosci. 2016 Mar 10;10:68. doi: 10.3389/fnhum.2016.00068. eCollection 2016.
Fibromyalgia is a chronic pain syndrome that is associated with maladaptive plasticity in neural central circuits. One of the neural circuits that are involved in pain in fibromyalgia is the primary motor cortex. We tested a combination intervention that aimed to modulate the motor system: transcranial direct current stimulation (tDCS) of the primary motor cortex (M1) and aerobic exercise (AE). In this phase II, sham-controlled randomized clinical trial, 45 subjects were assigned to 1 of 3 groups: tDCS + AE, AE only, and tDCS only. The following outcomes were assessed: intensity of pain, level of anxiety, quality of life, mood, pressure pain threshold, and cortical plasticity, as indexed by transcranial magnetic stimulation. There was a significant effect for the group-time interaction for intensity of pain, demonstrating that tDCS/AE was superior to AE [F (13, 364) = 2.25, p = 0.007] and tDCS [F (13, 364) = 2.33, p = 0.0056] alone. Post-hoc adjusted analysis showed a difference between tDCS/AE and tDCS group after the first week of stimulation and after 1 month intervention period (p = 0.02 and p = 0.03, respectively). Further, after treatment there was a significant difference between groups in anxiety and mood levels. The combination treatment effected the greatest response. The three groups had no differences regarding responses in motor cortex plasticity, as assessed by TMS. The combination of tDCS with aerobic exercise is superior compared with each individual intervention (cohen's d effect sizes > 0.55). The combination intervention had a significant effect on pain, anxiety and mood. Based on the similar effects on cortical plasticity outcomes, the combination intervention might have affected other neural circuits, such as those that control the affective-emotional aspects of pain.
(www.ClinicalTrials.gov), identifier NTC02358902.
纤维肌痛是一种慢性疼痛综合征，与神经中枢回路的适应性不良可塑性有关。参与纤维肌痛疼痛的神经回路之一是初级运动皮层。我们测试了一种旨在调节运动系统的联合干预措施：对初级运动皮层（M1）进行经颅直流电刺激（tDCS）和有氧运动（AE）。在这项II期、假刺激对照的随机临床试验中，45名受试者被分配到3组中的1组：tDCS + AE组、单纯AE组和单纯tDCS组。评估了以下结果：疼痛强度、焦虑水平、生活质量、情绪、压痛阈值和经颅磁刺激所指数的皮质可塑性。疼痛强度的组-时间交互作用有显著影响，表明tDCS/AE优于单纯AE [F (13, 364) = 2.25, p = 0.007] 和单纯tDCS [F (13, 364) = 2.33, p = 0.0056]。事后调整分析显示，在刺激第一周后和1个月干预期后，tDCS/AE组与tDCS组之间存在差异（分别为p = 0.02和p = 0.03）。此外，治疗后各组在焦虑和情绪水平上存在显著差异。联合治疗产生的反应最大。通过TMS评估，三组在运动皮层可塑性反应方面无差异。与每种单独干预相比，tDCS与有氧运动的联合效果更佳（科恩d效应大小> 0.55）。联合干预对疼痛、焦虑和情绪有显著影响。基于对皮质可塑性结果的类似影响，联合干预可能影响了其他神经回路，例如那些控制疼痛情感-情绪方面的神经回路。
