Lee Seung Yeol, Park Chang-Hyun, Cho Yoon Soo, Kim Laurie, Yoo Ji Won, Joo So Young, Seo Cheong Hoon
Department of Physical Medicine and Rehabilitation, Soonchunhyang University Bucheon Hospital, College of Medicine, Soonchunhyang University, Bucheon 14158, Korea.
Center for Neuroprosthetics and Brain Mind Institute, Swiss Federal Institute of Technology (EPFL), 1202 Geneva, Switzerland.
J Clin Med. 2022 Jul 22;11(15):4255. doi: 10.3390/jcm11154255.
Chronic pain is common after burn injuries, and post-burn neuropathic pain is the most important complication that is difficult to treat. Scrambler therapy (ST) is a non-invasive modality that uses patient-specific electrocutaneous nerve stimulation and is an effective treatment for many chronic pain disorders. This study used magnetic resonance imaging (MRI) to evaluate the pain network-related mechanisms that underlie the clinical effect of ST in patients with chronic burn-related pain. This prospective, double-blinded, randomized controlled trial (ClinicalTrials.gov: NCT03865693) enrolled 43 patients who were experiencing chronic neuropathic pain after unilateral burn injuries. The patients had moderate or greater chronic pain (a visual analogue scale (VAS) score of ≥5), despite treatment using gabapentin and other physical modalities, and were randomized 1:1 to receive real or sham ST sessions. The ST was performed using the MC5-A Calmare device for ten 45 min sessions (Monday to Friday for 2 weeks). Baseline and post-treatment parameters were evaluated subjectively using the VAS score for pain and the Hamilton Depression Rating Scale; MRI was performed to identify objective central nervous system changes by measuring the cerebral blood volume (CBV). After 10 ST sessions (two weeks), the treatment group exhibited a significant reduction in pain relative to the sham group. Furthermore, relative to the pre-ST findings, the post-ST MRI evaluations revealed significantly decreased CBV in the orbito-frontal gyrus, middle frontal gyrus, superior frontal gyrus, and gyrus rectus. In addition, the CBV was increased in the precentral gyrus and postcentral gyrus of the hemisphere associated with the burned limb in the ST group, as compared with the CBV of the sham group. Thus, a clinical effect from ST on burn pain was observed after 2 weeks, and a potential mechanism for the treatment effect was identified. These findings suggest that ST may be an alternative strategy for managing chronic pain in burn patients.
慢性疼痛在烧伤后很常见，而烧伤后神经性疼痛是最难治疗的重要并发症。扰频器疗法（ST）是一种非侵入性治疗方式，它利用针对患者的皮肤电刺激神经，是治疗多种慢性疼痛疾病的有效方法。本研究采用磁共振成像（MRI）来评估与疼痛网络相关的机制，这些机制是ST对慢性烧伤相关疼痛患者产生临床疗效的基础。这项前瞻性、双盲、随机对照试验（ClinicalTrials.gov：NCT03865693）招募了43名单侧烧伤后患有慢性神经性疼痛的患者。尽管使用了加巴喷丁和其他物理治疗方法，这些患者仍有中度或更严重的慢性疼痛（视觉模拟量表（VAS）评分≥5），并被随机分为1:1接受真实或假的ST治疗。使用MC5-A Calmare设备进行ST治疗，共十次，每次45分钟（周一至周五，为期2周）。使用VAS疼痛评分和汉密尔顿抑郁量表主观评估基线和治疗后的参数；通过测量脑血容量（CBV）进行MRI检查，以确定中枢神经系统的客观变化。经过10次ST治疗（两周）后，治疗组相对于假治疗组疼痛显著减轻。此外，相对于ST治疗前的结果，ST治疗后的MRI评估显示眶额回、额中回、额上回和直回的CBV显著降低。此外，与假治疗组的CBV相比，ST组中与烧伤肢体同侧半球的中央前回和中央后回的CBV增加。因此，观察到ST在2周后对烧伤疼痛有临床疗效，并确定了治疗效果的潜在机制。这些发现表明，ST可能是管理烧伤患者慢性疼痛的一种替代策略。
