Orthopedic Rehabilitation Department, Loewenstein Hospital, Ra'anana, Israel.
Clinical Pain Innovation Lab, University of Haifa, Haifa, Israel.
Pain Med. 2021 Feb 23;22(2):255-265. doi: 10.1093/pm/pnaa388.
Current analgesic treatments for phantom pain are not optimal. One well-accepted yet limited nonpharmacological option is mirror therapy, which is thought to counterbalance abnormal plasticity. Transcranial direct current stimulation (tDCS) is an emerging approach believed to affect the membrane potential and activity threshold of cortical neurons. tDCS analgesic effectiveness, however, is mild and short, rendering it a noneffective stand-alone treatment. This study aimed to assess if a combination of mirror therapy with tDCS results in a superior analgesic effect as compared with mirror therapy alone in patients suffering from phantom pain due to recent amputation.
Following ethical approval, eligible patients provided informed consent and were randomly assigned to a study treatment group that continued for 2 weeks (once daily): 1) mirror therapy; 2) mirror therapy and sham tDCS; or 3) mirror therapy and tDCS. Assessments were done before treatment; at the end of treatment weeks 1 and 2; and at 1 week, 1 month, and 3 months following treatment. The primary outcome measure was pain intensity. Secondary measures were derived from the Short Form McGill Pain Questionnaire and the Brief Pain Inventory.
Thirty patients were recruited, and 29 patients completed the study. Three months following treatment, pain intensity was significantly (P<0.001) reduced in the combined treatment group (reduction of 5.4±3.3 points) compared with the other study arms (mirror therapy, 1.2±1.1; mirror therapy and sham tDCS, 2.7±3.2). All secondary outcome results were in line with these findings.
Combining tDCS with mirror therapy results in a robust long-lasting analgesic effect. These encouraging findings may contribute to the understanding of the underlying mechanisms of phantom pain.
目前针对幻肢痛的镇痛治疗效果并不理想。一种公认但有限的非药物选择是镜像疗法，它被认为可以抵消异常的可塑性。经颅直流电刺激（tDCS）是一种新兴的方法，被认为可以影响皮质神经元的膜电位和活动阈值。然而，tDCS 的镇痛效果微弱且短暂，使其成为一种无效的独立治疗方法。本研究旨在评估在因近期截肢而患有幻肢痛的患者中，与单独使用镜像疗法相比，镜像疗法联合 tDCS 是否会产生更好的镇痛效果。
在获得伦理批准后，符合条件的患者提供知情同意并被随机分配到研究治疗组，治疗持续 2 周（每天一次）：1）镜像疗法；2）镜像疗法和假 tDCS；或 3）镜像疗法和 tDCS。评估在治疗前；在治疗第 1 周和第 2 周结束时；以及治疗后 1 周、1 个月和 3 个月进行。主要结局指标是疼痛强度。次要指标来自于简明 McGill 疼痛问卷和简短疼痛量表。
共招募了 30 名患者，其中 29 名患者完成了研究。治疗 3 个月后，联合治疗组（疼痛强度降低 5.4±3.3 分）与其他研究组（镜像疗法，1.2±1.1 分；镜像疗法和假 tDCS，2.7±3.2 分）相比，疼痛强度显著（P<0.001）降低。所有次要结局结果均与这些发现一致。
将 tDCS 与镜像疗法相结合可产生强大且持久的镇痛效果。这些令人鼓舞的发现可能有助于理解幻肢痛的潜在机制。
