Yoo Hye Bin, Ost Jan, Joos Wim, Van Havenbergh Tony, De Ridder Dirk, Vanneste Sven
School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX.
St. Augustinus Hospital, Antwerp, Belgium.
Clin J Pain. 2018 May;34(5):421-427. doi: 10.1097/AJP.0000000000000552.
Fibromyalgia (FM) is a type of chronic musculoskeletal pain without a clear peripheral origin of nociception, often associated with depression. The underlying pathophysiology involves changes in a functional network that is related to pain and emotional processing in the central nervous system. Transcranial direct current stimulation (tDCS) targeting the dorsolateral prefrontal cortex or the occipital nerve (ON) is a noninvasive neuromodulation technique capable of improving fibromyalgia symptoms. This study aims to test the effect of combining 2 targets of stimulation using tDCS.
We applied ON-tDCS in isolation or coupled with pre-ONS right-anode bifrontal tDCS and assessed its effect on fibromyalgia using the Fibromyalgia Impact Questionnaire, the Beck Depression Inventory, and Numeric Rating Scale for pain scores. These measures were compared with a sham control group using repeated measures analysis of variance.
The interaction effect of stimulation trials and the protocols of sham versus ON-tDCS were significant for the impact, distress, and pain caused by fibromyalgia (P<0.05). The interaction effect of trials and protocols of sham versus ON-tDCS with bifrontal tDCS was significant for distress (P<0.01), and it showed a trend of improvement for impact and pain (P<0.1). On the basis of the nonsignificant interaction effect of ON-tDCS versus ON-tDCS with bifrontal tDCS (P>0.1), adding bifrontal tDCS was found not to improve the treatment effect of ON-tDCS in any of the tested clinical outcome measures.
This study suggests that adding right-anode bifrontal tDCS to ONS has no added benefit in improving fibromyalgia-related symptoms.
纤维肌痛（FM）是一种慢性肌肉骨骼疼痛，其伤害感受的外周起源不明确，常与抑郁症相关。潜在的病理生理学涉及与中枢神经系统疼痛和情绪处理相关的功能网络变化。针对背外侧前额叶皮层或枕神经（ON）的经颅直流电刺激（tDCS）是一种能够改善纤维肌痛症状的非侵入性神经调节技术。本研究旨在测试使用tDCS联合两个刺激靶点的效果。
我们单独应用枕神经tDCS或联合枕神经前右侧阳极双额叶tDCS，并使用纤维肌痛影响问卷、贝克抑郁量表和疼痛评分数字评定量表评估其对纤维肌痛的影响。使用重复测量方差分析将这些测量结果与假手术对照组进行比较。
刺激试验与假手术对照和枕神经tDCS方案之间的交互作用对于纤维肌痛引起的影响、痛苦和疼痛具有显著意义（P<0.05）。试验与假手术对照和枕神经tDCS联合双额叶tDCS方案之间的交互作用对于痛苦具有显著意义（P<0.01），并且在影响和疼痛方面显示出改善趋势（P<0.1）。基于枕神经tDCS与枕神经tDCS联合双额叶tDCS之间无显著交互作用（P>0.1），发现在任何测试的临床结局指标中，添加双额叶tDCS均未改善枕神经tDCS的治疗效果。
本研究表明，在枕神经刺激基础上添加右侧阳极双额叶tDCS对改善纤维肌痛相关症状并无额外益处。
