颅电刺激治疗晚期癌症患者的抑郁、焦虑、睡眠障碍和疼痛：一项初步研究。

Cranial Electrotherapy Stimulation for the Management of Depression, Anxiety, Sleep Disturbance, and Pain in Patients With Advanced Cancer: A Preliminary Study.

机构信息

Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.

Center for Nursing Research, University of Texas School of Nursing, Houston, Texas, USA.

出版信息

J Pain Symptom Manage. 2018 Feb;55(2):198-206. doi: 10.1016/j.jpainsymman.2017.08.027. Epub 2017 Sep 21.

DOI:10.1016/j.jpainsymman.2017.08.027

PMID:28870799

Abstract

CONTEXT

Cranial electrotherapy stimulation (CES) is a safe modulation of brain activity for treating depression, anxiety, insomnia, and pain. However, there are no published studies in patients with advanced cancer (ACPs).

OBJECTIVES

The aim of the study was to determine the feasibility and preliminary efficacy of a four-week CES intervention on depression, anxiety, sleep disturbance, and pain scores. Concurrent salivary biomarker studies were conducted.

METHODS

In this one group open label pre- and post-intervention study with a four-week CES intervention, ACPs with one or more of four moderate intensity (≥3/10) Edmonton Symptom Assessment Scale (ESAS) symptoms (depression, anxiety, sleep disturbance, and pain) were eligible. Adherence (0%-100%), satisfaction rates (0-10), and safety were assessed. ESAS, Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index, Brief Pain Inventory, and salivary levels (cortisol, alpha amylase, C-reactive protein, and interleukin-1β, and interleukin-6) were assessed from baseline to Week 4.

RESULTS

Thirty-three of 36 patients (92%) completed the CES. Median (interquartile range) adherence CES use and satisfaction scores were 93% (89-100) and 10% (9-10), respectively, and the adherence criteria was met in the study. CES use was safe (no Grade 3 or higher adverse events). HADS anxiety (P < 0.001), HADS depression (P = 0.024), ESAS anxiety (P = 0.001), ESAS depression (P = 0.025), Brief Pain Inventory pain (P = 0.013), Pittsburgh Sleep Quality Index daytime dysfunction (P = 0.002), and medication use (P = 0.006) scores improved after four-week CES treatment.

CONCLUSION

In this preliminary study, we found that the use of CES was safe and feasible in ACP. The use of CES was associated with significant improvement of depression, anxiety, pain, and sleep scores. These findings support further studies of CES in ACP for symptom control.

摘要

背景

颅电刺激（CES）是一种安全的大脑活动调节方法，可用于治疗抑郁症、焦虑症、失眠和疼痛。然而，目前尚无针对晚期癌症患者（ACP）的相关研究。

目的

本研究旨在确定为期四周的 CES 干预对抑郁、焦虑、睡眠障碍和疼痛评分的可行性和初步疗效。同时进行了唾液生物标志物研究。

方法

在这项为期四周 CES 干预的单组开放性标签预-后干预研究中，纳入了具有≥3/10 的 Edmonton 症状评估量表（ESAS）四项中度强度（抑郁、焦虑、睡眠障碍和疼痛）症状之一或多项症状的 ACP。评估了依从性（0%-100%）、满意度（0-10）和安全性。从基线到第 4 周评估 ESAS、医院焦虑抑郁量表（HADS）、匹兹堡睡眠质量指数、简明疼痛量表和唾液水平（皮质醇、α-淀粉酶、C 反应蛋白、白细胞介素-1β和白细胞介素-6）。

结果

36 例患者中有 33 例（92%）完成了 CES。CES 使用的中位数（四分位距）依从率和满意度评分分别为 93%（89-100）和 10%（9-10），并且达到了研究中的依从性标准。CES 使用是安全的（无 3 级或更高级别的不良事件）。HADS 焦虑（P<0.001）、HADS 抑郁（P=0.024）、ESAS 焦虑（P=0.001）、ESAS 抑郁（P=0.025）、简明疼痛量表疼痛（P=0.013）、匹兹堡睡眠质量指数日间功能障碍（P=0.002）和药物使用（P=0.006）评分在四周 CES 治疗后均有改善。