Rahin Hedayat, Jackson Walker Scot, Thordstein Magnus
Department of Clinical Neurophysiology, Region Östergötland University Hospital, 58185 Linköping, Sweden.
Department of Clinical and Experimental Medicine, Linköping University, 58185 Linköping, Sweden.
Brain Sci. 2023 Jan 30;13(2):229. doi: 10.3390/brainsci13020229.
: The neuromodulating effects of transcutaneous-spinal Direct Current Stimulation (tsDCS) have been reported to block pain signaling. For patients with chronic pain, tsDCS could be a potential treatment option. To approach this, we studied the effect of anodal tsDCS on patients with neuropathic pain approaching an optimal paradigm including the investigation of different outcome predictors. : In this randomized, double-blinded, sham-controlled crossover study we recruited twenty patients with neurophysiologically evaluated neuropathic pain due to polyneuropathy (PNP). Variables (VAS; pain and sleep quality) were reported daily, one week prior to, and one week after the stimulation/sham period. Anodal tsDCS (2.5 mA, 20 min) was given once daily for three days during one week. BDNF-polymorphism, pharmacological treatment, and body mass index (BMI) of all the patients were investigated. : Comparing the effects of sham and real stimulation at the group level, there was a tendency towards reduced pain, but no significant effects were found. However, for sleep quality a significant improvement was seen. At the individual level, 30 and 35% of the subjects had a clinically significant improvement of pain level and sleep quality, respectively, the first day after the stimulation. Both effects were reduced over the coming week and these changes were negatively correlated. The BDNF polymorphism Val66Met was carried by 35% of the patients and this group was found to have a lower general level of pain but there was no significant difference in the tsDCS response effect. Neither pharmacologic treatment or BMI influenced the treatment effect. : Short-term and sparse anodal thoracic tsDCS reduces pain and improves sleep with large inter-individual differences. Roughly 30% will benefit in a clinically meaningful way. The BDNF genotype seems to influence the level of pain that PNP produces. Individualized and intensified tsDCS may be a treatment option for neuropathic pain due to PNP.
经皮脊髓直流电刺激（tsDCS）的神经调节作用据报道可阻断疼痛信号。对于慢性疼痛患者，tsDCS可能是一种潜在的治疗选择。为了探讨这一点，我们研究了阳极tsDCS对神经性疼痛患者的影响，采用了接近最佳模式的方法，包括对不同结果预测因素的研究。
在这项随机、双盲、假对照交叉研究中，我们招募了20名经神经生理学评估因多发性神经病（PNP）导致神经性疼痛的患者。在刺激/假刺激期之前一周和之后一周，每天报告变量（视觉模拟评分法；疼痛和睡眠质量）。在一周内，每天给予阳极tsDCS（2.5毫安，20分钟），共三天。对所有患者的脑源性神经营养因子（BDNF）多态性、药物治疗和体重指数（BMI）进行了研究。
在组水平上比较假刺激和真实刺激的效果，疼痛有减轻的趋势，但未发现显著效果。然而，睡眠质量有显著改善。在个体水平上，分别有30%和35%的受试者在刺激后的第一天疼痛水平和睡眠质量有临床显著改善。两种效果在接下来的一周内均有所降低，且这些变化呈负相关。35%的患者携带BDNF多态性Val66Met，该组患者的总体疼痛水平较低，但tsDCS反应效果无显著差异。药物治疗和BMI均未影响治疗效果。
短期和稀疏的阳极胸部tsDCS可减轻疼痛并改善睡眠，但个体差异较大。大约30%的患者将从临床上获得有意义的益处。BDNF基因型似乎影响PNP产生的疼痛水平。个体化和强化的tsDCS可能是治疗PNP所致神经性疼痛的一种选择。
