a Laboratory of Neuromodulation & Center for Clinical Research Learning, Department of Physical Medicine and Rehabilitation , Spaulding Rehabilitation Hospital, Harvard Medical School , Boston , MA , USA.
Expert Rev Med Devices. 2018 Dec;15(12):863-873. doi: 10.1080/17434440.2018.1551129. Epub 2018 Dec 3.
Fibromyalgia affects more than 5 million people in the United States and has a detrimental impact on individuals' quality of life. Current pharmacological treatments provide limited benefits to relieve the pain of fibromyalgia, along with a risk of adverse effects; a scenario that explains the increasing interest for multimodal approaches. A tailored strategy to focus on this dysfunctional endogenous pain inhibitory system is transcranial direct current stimulation (tDCS) of the primary motor cortex. By combining tDCS with aerobic exercise, the effects can be optimized. Areas covered: The relevant literature was reviewed and discussed the methodological issues for designing a mechanistic clinical trial to test this combined intervention. Also, we reviewed the neural control of different pathways that integrate the endogenous pain inhibitory system, as well as the effects of tDCS and aerobic exercise both alone and combined. In addition, potential neurophysiological assessments are addressed: conditioned pain modulation, temporal slow pain summation, transcranial magnetic stimulation, and electroencephalography in the context of fibromyalgia. Expert commentary: By understanding the neural mechanisms underlying pain processing and potential optimized interventions in fibromyalgia with higher accuracy, the field has an evident potential of advancement in the direction of new neuromarkers and tailored therapies.
纤维肌痛影响美国超过 500 万人，对个人的生活质量产生不利影响。目前的药物治疗提供了有限的缓解纤维肌痛疼痛的益处，同时存在不良反应的风险；这种情况解释了对多模式方法越来越感兴趣的原因。针对这种功能失调的内源性疼痛抑制系统的定制策略是对初级运动皮层进行经颅直流电刺激（tDCS）。通过将 tDCS 与有氧运动相结合，可以优化效果。涵盖领域：综述了相关文献，并讨论了设计一项针对这种联合干预措施的机制临床试验的方法学问题。此外，我们还回顾了整合内源性疼痛抑制系统的不同途径的神经控制，以及 tDCS 和有氧运动单独和联合使用的效果。此外，还涉及潜在的神经生理学评估：在纤维肌痛背景下的条件性疼痛调节、时间性慢痛总和、经颅磁刺激和脑电图。专家评论：通过更准确地了解疼痛处理的神经机制和纤维肌痛中潜在的优化干预措施，该领域在新的神经生物标志物和定制疗法方面具有明显的进展潜力。
