经颅直流电刺激治疗慢性腰痛的情感症状和功能：一项双盲、随机、安慰剂对照的初步试验。
Transcranial Direct Current Stimulation for Affective Symptoms and Functioning in Chronic Low Back Pain: A Pilot Double-Blinded, Randomized, Placebo-Controlled Trial.
机构信息
Butler Hospital, Providence, Rhode Island.
Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
出版信息
Pain Med. 2019 Jun 1;20(6):1166-1177. doi: 10.1093/pm/pny188.
BACKGROUND AND OBJECTIVE
Chronic low back pain (CLBP) is highly prevalent, with a substantial psychosocial burden. Pain has both sensory and affective components. The latter component is a significant driver of disability and psychiatric comorbidity but is often inadequately treated. Previously we reported that noninvasive transcranial direct current stimulation (tDCS) may modulate pain-associated affective distress. Here we tested whether 10 daily tDCS sessions aimed to inhibit the left dorsal anterior cingulate cortex (dACC), a region strongly implicated in the affective component of pain, would produce selective reduction in pain-related symptoms.
METHODS
In this multisite, double-blinded, randomized placebo-controlled trial (RCT), 21 CLBP patients received 10 weekday sessions of 2-mA active tDCS or sham (20 minutes/session). A cathodal electrode was placed over FC1 (10-20 electroencephalography coordinates), and an identical anodal return electrode was placed over the contralateral mastoid. Participants rated pain intensity, acceptance, interference, disability, and anxiety, plus general anxiety and depression.
RESULTS
Regression analysis noted significantly less pain interference (P =0.002), pain disability (P =0.001), and depression symptoms (P =0.003) at six-week follow-up for active tDCS vs sham. Omnibus tests suggested that these improvements were not merely due to baseline (day 1) group differences.
CONCLUSIONS
To our knowledge, this is the first double-blinded RCT of multiple tDCS sessions targeting the left dACC to modulate CLBP's affective symptoms. Results are encouraging, including several possible tDCS-associated improvements. Better-powered RCTs are needed to confirm these effects. Future studies should also consider different stimulation schedules, additional cortical targets, high-density multi-electrode tDCS arrays, and multimodal approaches.
背景与目的
慢性下背痛（CLBP）发病率高，社会心理负担重。疼痛既有感觉成分，也有情感成分。后者是导致残疾和精神共病的重要因素，但往往治疗不足。我们之前的研究报告称，非侵入性经颅直流电刺激（tDCS）可能调节与疼痛相关的情感困扰。在这里，我们测试了 10 次每日 tDCS 治疗是否旨在抑制左侧背侧前扣带皮层（dACC），该区域强烈参与疼痛的情感成分，是否会产生与疼痛相关的症状的选择性减少。
方法
在这项多中心、双盲、随机安慰剂对照试验（RCT）中，21 名 CLBP 患者接受了 10 个工作日的 2 mA 活性 tDCS 或假刺激（20 分钟/次）。阴极电极置于 FC1（10-20 脑电图坐标），相同的阳极返回电极置于对侧乳突。参与者评估疼痛强度、接受度、干扰、残疾和焦虑，以及一般焦虑和抑郁。
结果
回归分析表明，与假刺激相比，活跃 tDCS 组在六周随访时疼痛干扰（P =0.002）、疼痛残疾（P =0.001）和抑郁症状（P =0.003）明显减少。整体检验表明，这些改善不仅仅是由于基线（第 1 天）组间差异。
结论
据我们所知，这是第一个针对左 dACC 进行多次 tDCS 治疗以调节 CLBP 情感症状的双盲 RCT。结果令人鼓舞，包括一些可能与 tDCS 相关的改善。需要更好的 RCT 来证实这些效果。未来的研究还应考虑不同的刺激方案、额外的皮质靶点、高密度多电极 tDCS 阵列和多模态方法。
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