经颅直流电刺激对纤维肌痛症疼痛、情绪和血清内啡肽水平的影响：一项双盲、随机临床试验。

Effects of transcranial direct current stimulation on pain, mood and serum endorphin level in the treatment of fibromyalgia: A double blinded, randomized clinical trial.

机构信息

Department of Neuropsychiatry, Faculty of Medicine, Assiut University, Assuit, Egypt.

Department of Rheumatology and Rehabilitation, Faculty of Medicine, Assiut University, Assiut, Egypt.

出版信息

Brain Stimul. 2017 Sep-Oct;10(5):893-901. doi: 10.1016/j.brs.2017.06.006. Epub 2017 Jun 23.

DOI:10.1016/j.brs.2017.06.006

PMID:28684258

Abstract

BACKGROUND

Recent studies have shown that novel neuro-modulating techniques can have pain-relieving effects in the treatment of chronic pain. The aim of this work is to evaluate the effects of transcranial direct current stimulation (tDCS) in relieving fibromyalgia pain and its relation with beta-endorphin changes.

MATERIAL AND METHODS

Forty eligible patients with primary fibromyalgia were randomized to receive real anodal tDCS or sham tDCS of the left motor cortex (M1) daily for 10 days. Each patient was evaluated using widespread pain index (WPI), symptom severity of fibromyalgia (SS), visual analogue scale (VAS), and determination of pain threshold as a primary outcome. Hamilton depression and anxiety scales (HAM-D and HAM-A) and estimation of serum beta-endorphin level pre and post-sessions were used as secondary outcome. All rating scales were conducted at the baseline, after the 5th, 10th session, 15 days and 1 month after the end of the sessions.

RESULTS

Eighteen patients from each group completed the follow-up schedule with no significant difference between them regarding the duration of illness or the baseline scales. A significant TIME × GROUP interaction for each rating scale (WPI, SS, VAS, pain threshold, HAM-A, HAM-D) indicated that the effect of treatment differed in the two groups with higher improvement in the experimental scores of the patients in the real tDCS group (P = 0.001 for WPI, SS, VAS, pain threshold, and 0.002, 0.03 for HAM-A, HAM-D respectively). Negative correlations between changes in serum beta-endorphin level and the changes in different rating scales were found (P = 0.003, 0.003, 0.05, 0.002, 0002 for WPI, SS, VAS, HAM-A, and HAM-D respectively).

CONCLUSION

Ten sessions of real tDCS over M1 can induce pain relief and mood improvement in patients with fibromyalgia, which were found to be related to changes in serum endorphin levels. ClinicalTrials.gov Identifier: NCT02704611.

摘要

背景

最近的研究表明，新型神经调节技术在治疗慢性疼痛方面具有缓解疼痛的效果。本研究旨在评估经颅直流电刺激（tDCS）缓解纤维肌痛疼痛的效果及其与β-内啡肽变化的关系。

材料和方法

40 名符合条件的原发性纤维肌痛患者被随机分为真阳极 tDCS 或左运动皮层（M1）假阳极 tDCS 组，每天治疗 10 天。每位患者均采用广泛性疼痛指数（WPI）、纤维肌痛症状严重程度（SS）、视觉模拟评分（VAS）和疼痛阈值评估作为主要结局。汉密尔顿抑郁和焦虑量表（HAM-D 和 HAM-A）和血清β-内啡肽水平的测定作为次要结局。所有评分量表均在基线、第 5 次、第 10 次治疗后、治疗结束后 15 天和 1 个月进行。

结果

每组各有 18 名患者完成了随访计划，两组患者的病程或基线评分无显著差异。每个评分量表的 TIME×GROUP 交互作用均有统计学意义（WPI、SS、VAS、疼痛阈值、HAM-A、HAM-D），表明两组治疗效果不同，真阳极 tDCS 组患者的实验评分改善更高（WPI、SS、VAS、疼痛阈值的 P 值分别为 0.001、0.001、0.001、0.001，HAM-A、HAM-D 的 P 值分别为 0.002、0.03）。还发现血清β-内啡肽水平的变化与不同评分量表的变化之间存在负相关（WPI、SS、VAS、HAM-A、HAM-D 的 P 值分别为 0.003、0.003、0.05、0.002、0002）。