Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia.
The Menninger Clinic, Houston, Texas.
Pain Med. 2018 Apr 1;19(4):677-685. doi: 10.1093/pm/pnx098.
Cognitive behavioral therapy has been shown to be effective for treating chronic pain, and a growing literature shows the potential analgesic effects of minimally invasive brain stimulation. However, few studies have systematically investigated the potential benefits associated with combining approaches. The goal of this pilot laboratory study was to investigate the combination of a brief cognitive restructuring intervention and transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex in affecting pain tolerance.
Randomized, double-blind, placebo-controlled laboratory pilot.
Medical University of South Carolina.
A total of 79 healthy adult volunteers.
Subjects were randomized into one of six groups: 1) anodal tDCS plus a brief cognitive intervention (BCI); 2) anodal tDCS plus pain education; 3) cathodal tDCS plus BCI; 4) cathodal tDCS plus pain education; 5) sham tDCS plus BCI; and 6) sham tDCS plus pain education. Participants underwent thermal pain tolerance testing pre- and postintervention using the Method of Limits.
A significant main effect for time (pre-post intervention) was found, as well as for baseline thermal pain tolerance (covariate) in the model. A significant time × group interaction effect was found on thermal pain tolerance. Each of the five groups that received at least one active intervention outperformed the group receiving sham tDCS and pain education only (i.e., control group), with the exception of the anodal tDCS + education-only group. Cathodal tDCS combined with the BCI produced the largest analgesic effect.
Combining cathodal tDCS with BCI yielded the largest analgesic effect of all the conditions tested. Future research might find stronger interactive effects of combined tDCS and a cognitive intervention with larger doses of each intervention. Because this controlled laboratory pilot employed an acute pain analogue and the cognitive intervention did not authentically represent cognitive behavioral therapy per se, the implications of the findings on chronic pain management remain unclear.
认知行为疗法已被证明对治疗慢性疼痛有效，越来越多的文献表明微创脑刺激具有潜在的镇痛作用。然而，很少有研究系统地调查了联合治疗方法的潜在益处。本实验室初步研究的目的是调查短暂的认知重构干预和经颅直流电刺激（tDCS）联合应用于左背外侧前额叶皮层对疼痛耐受力的影响。
随机、双盲、安慰剂对照的实验室初步研究。
南卡罗来纳医科大学。
共 79 名健康成年志愿者。
将受试者随机分为六组之一：1）阳极 tDCS 加简短认知干预（BCI）；2）阳极 tDCS 加疼痛教育；3）阴极 tDCS 加 BCI；4）阴极 tDCS 加疼痛教育；5）假 tDCS 加 BCI；6）假 tDCS 加疼痛教育。参与者在干预前后使用极限法进行热痛耐受测试。
模型中发现时间（干预前后）有显著的主效应，以及基线热痛耐受（协变量）有显著的主效应。在热痛耐受方面，发现时间与组之间存在显著的交互作用效应。接受至少一种有效干预的五组中的每一组都优于仅接受假 tDCS 和疼痛教育的组（即对照组），除了阳极 tDCS 加教育组。阴极 tDCS 联合 BCI 产生的镇痛效果最大。
在所有测试的条件中，将阴极 tDCS 与 BCI 联合使用产生了最大的镇痛效果。未来的研究可能会发现更大剂量的联合 tDCS 和认知干预的更强的相互作用效应。由于本对照实验室初步研究采用了急性疼痛模拟，并且认知干预本身并没有真正代表认知行为疗法，因此研究结果对慢性疼痛管理的意义尚不清楚。
