Lagueux Émilie, Bernier Michaël, Bourgault Patricia, Whittingstall Kevin, Mercier Catherine, Léonard Guillaume, Laroche Sarah, Tousignant-Laflamme Yannick
Research Center of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS).
Faculty of Medicine and Health Sciences, School of Rehabilitation.
Clin J Pain. 2018 Feb;34(2):145-154. doi: 10.1097/AJP.0000000000000522.
BACKGROUND: The efficacy of Graded Motor Imagery (GMI) for the management of Complex Regional Pain Syndrome (CRPS) is supported by evidence, but its treatment effect remains generally modest. Transcranial Direct Current Stimulation (tDCS) has been advocated as an adjunct intervention to enhance the effect of motor imagery approaches in pain populations. OBJECTIVE: The purpose of this study was to investigate the effectiveness of GMI+active tDCS compared with the GMI+sham tDCS in the treatment of CRPS type I. METHODS: A total of 22 patients (n=11/group) were randomly assigned to the experimental (GMI+tDCS) or placebo (GMI+sham tDCS) group. GMI treatments lasted 6 weeks; anodal tDCS was applied over the motor cortex for 5 consecutive days during the first 2 weeks and once a week thereafter. Changes in pain perception, quality of life, kinesiophobia, pain catastrophizing, anxiety and mood were monitored after 6 weeks of treatment (T1) and 1-month posttreatment (T2). RESULTS: GMI+tDCS induced no statistically significant reduction in pain compared with GMI+sham tDCS. Although we observed significant group differences in kinesiophobia (P=0.012), pain catastrophizing (P=0.049), and anxiety (P=0.046) at T1, these improvements were not maintained at T2 and did not reached a clinically significant difference. DISCUSSION: We found no added value of tDCS combined with GMI treatments for reducing pain in patients with chronic CRPS. However, given that GMI+sham tDCS induced no significant change, further studies comparing GMI+tDCS and tDCS alone are needed to further document tDCS's effect in CRPS.
背景：有证据支持分级运动想象（GMI）对复杂性区域疼痛综合征（CRPS）的治疗效果，但其治疗效果总体上仍较为有限。经颅直流电刺激（tDCS）已被提倡作为一种辅助干预措施，以增强运动想象方法在疼痛患者群体中的效果。 目的：本研究旨在探讨GMI联合主动tDCS与GMI联合假tDCS在治疗Ⅰ型CRPS中的有效性。 方法：总共22例患者（每组n = 11）被随机分配至实验组（GMI + tDCS）或安慰剂组（GMI + 假tDCS）。GMI治疗持续6周；在前2周内，阳极tDCS连续5天应用于运动皮层，此后每周1次。在治疗6周后（T1）和治疗后1个月（T2）监测疼痛感知、生活质量、运动恐惧、疼痛灾难化、焦虑和情绪的变化。 结果：与GMI + 假tDCS相比，GMI + tDCS在疼痛减轻方面未产生统计学上的显著差异。尽管我们在T1时观察到两组在运动恐惧（P = 0.012）、疼痛灾难化（P = 0.049）和焦虑（P = 0.046）方面存在显著差异，但这些改善在T2时未持续，且未达到临床显著差异。 讨论：我们发现tDCS联合GMI治疗在减轻慢性CRPS患者疼痛方面没有额外价值。然而，鉴于GMI + 假tDCS未引起显著变化，需要进一步开展比较GMI + tDCS和单独tDCS的研究，以进一步证明tDCS在CRPS中的作用。
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