School of Psychology, University of Leeds, Leeds, United Kingdom.
School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, United Kingdom.
J Pain. 2020 Nov-Dec;21(11-12):1085-1100. doi: 10.1016/j.jpain.2020.01.003. Epub 2020 Jan 23.
Fibromyalgia is a debilitating condition characterized by chronic widespread pain. It is believed to be caused by dysfunction of the central nervous system (CNS) but current treatments are largely ineffective. Transcranial direct current stimulation (tDCS), a neuromodulation technique that targets the CNS, may offer a new line of treatment.
To systematically review the most up-to-date literature and perform a meta-analysis of the effects of tDCS on pain intensity in fibromyalgia.
The following databases were searched from inception: Medline (Ovid), PsychInfo, CINAHL, Cochrane Library, and Web of Science. Studies were eligible if they were randomized controlled trials, quasi-randomized trials, and nonrandomized. Crossover and parallel-group design studies were included. Risk of bias was assessed for all included studies. Meta-analysis was conducted on studies investigating pain intensity after tDCS in participants with fibromyalgia and analyzed using standardized mean difference and 95% confidence intervals.
Fourteen clinical studies were included. Ten were controlled trials and 4 were within-subjects crossover studies. Meta-analysis of data from 8 controlled trials provides tentative evidence of pain reduction when active tDCS is delivered compared to sham. However, substantial statistical heterogeneity and high risk of bias of primary studies prevent more conclusive recommendations being made.
tDCS is a safe intervention with the potential to lower pain intensity in fibromyalgia. However, there is a need for more empirical research of the neural target sites and optimum stimulation parameters to achieve the greatest effects before conducting further clinical studies.
This systematic review and meta-analysis synthesizes current evidence for the clinical effectiveness of tDCS in the treatment of fibromyalgia pain. There is only tentative evidence of pain reduction when active tDCS is compared to sham. High heterogeneity and risk of bias across studies suggest a need for further empirical research.
纤维肌痛是一种衰弱性疾病，其特征为慢性广泛性疼痛。人们认为它是由中枢神经系统（CNS）功能障碍引起的，但目前的治疗方法大多无效。经颅直流电刺激（tDCS）是一种针对 CNS 的神经调节技术，可能提供新的治疗方法。
系统回顾最新文献，并对 tDCS 治疗纤维肌痛疼痛强度的效果进行荟萃分析。
从成立之初开始搜索以下数据库：Medline（Ovid）、PsychInfo、CINAHL、Cochrane 图书馆和 Web of Science。如果研究为随机对照试验、准随机试验和非随机试验，则符合入选标准。包括交叉和平行组设计的研究。对所有纳入研究进行偏倚风险评估。对研究 tDCS 后纤维肌痛患者疼痛强度的研究进行荟萃分析，使用标准化均数差和 95%置信区间进行分析。
纳入了 14 项临床研究。其中 10 项为对照试验，4 项为自身对照交叉试验。对 8 项对照试验的数据进行荟萃分析，提供了在给予活跃 tDCS 时与假刺激相比疼痛减轻的初步证据。然而，主要研究的统计异质性大且偏倚风险高，妨碍了更明确的推荐意见的提出。
tDCS 是一种安全的干预措施，具有降低纤维肌痛疼痛强度的潜力。然而，在进行进一步的临床研究之前，需要对神经靶位和最佳刺激参数进行更多的实证研究，以获得最大效果。
本系统评价和荟萃分析综合了当前关于 tDCS 治疗纤维肌痛疼痛的临床疗效证据。与假刺激相比，活跃 tDCS 时仅存在疼痛减轻的初步证据。研究之间的高度异质性和偏倚风险表明需要进一步进行实证研究。
