针刺治疗慢性疼痛合并重度抑郁症患者的临床疗效及免疫效应：一项双盲、随机对照交叉研究。

Clinical efficacy and immune effects of acupuncture in patients with comorbid chronic pain and major depression disorder: A double-blinded, randomized controlled crossover study.

作者信息

Liao Hsien-Yin, Satyanarayanan Senthil Kumaran, Lin Yi-Wen, Su Kuan-Pin

机构信息

School of Post-Baccalaureate Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan; Department of Acupuncture, China Medical University Hospital, Taichung 40402, Taiwan.

Mind-Body Interface Research Center (MBI-Lab), China Medical University Hospital, Taichung, Taiwan.

出版信息

Brain Behav Immun. 2023 May;110:339-347. doi: 10.1016/j.bbi.2023.03.016. Epub 2023 Mar 21.

DOI:10.1016/j.bbi.2023.03.016

PMID:36948325

Abstract

BACKGROUND

Depression and pain are highly comorbid and share biological mechanisms. Acupuncture is commonly used to manage both pain and depression, but the choice of acupoints for specific disorders differs. This study aimed to investigate whether specific acupuncture intervention on pain- and depression-acupoints would have specific efficacy and immune effects in patients with comorbid chronic pain and major depressive disorder (MDD).

METHODS

We performed a subject- and assessor-blinded, crossover, and randomized controlled clinical trial of depression- and pain-specific acupuncture intervention and measured clinical responses and proinflammatory cytokines in patients with comorbid chronic pain and MDD. Specific acupoints for pain and depression were used in random order with a washout interval. Forty-seven patients were enrolled and randomly assigned to two groups: (1) the depression-pain group (23 patients who were treated with depression-specific acupoints and then the pain-specific acupoints after the washout) and (2) pain-depression group (24 patients with the reverse order).

RESULTS

The pain-specific acupoints for pain did not reduce Brief Pain Inventory scores to a significantly greater degree (-0.97 ± 1.69) than the depression-specific acupoints (-0.28 ± 1.88); likewise, the depression-specific acupoints did not significantly ameliorate Hamilton Depression Rating Scale (-4.59 ± 6.02) than the pain-specific acupoints (-6.69 ± 6.61). The pain-specific acupoints improved Beck Depression Inventory-Second Edition (-6.74 ± 9.76) even better than the depression-specific acupoints (-1.92 ± 10.74). The depression-specific acupoints did not significantly decrease the depression-related interleukin (IL)-6 level (-1.24 ± 6.67) than the pain-specific acupoints (-0.60 ± 4.36). The changed levels of IL-1β, tumor necrosis factor (TNF)-α between the depression-specific acupoints (-37.41 ± 194.49; -12.53 ± 54.68) and the pain-specific acupoints (-15.46 ± 87.56; -7.28 ± 27.86) could not reach significantly different, too.

CONCLUSION

This study rejected our hypothesis that the pain-specific acupoints might produce superior analgesic effects than the depression-specific acupoints and vice versa. The cytokine results might imply that pain and depression share common biological mechanisms. (trial registration: https://www.

CLINICALTRIALS

gov: NCT03328819).

摘要

背景

抑郁症与疼痛高度共病且具有共同的生物学机制。针灸常用于治疗疼痛和抑郁症，但针对特定病症的穴位选择有所不同。本研究旨在探讨对疼痛穴位和抑郁穴位进行特定的针灸干预，对于慢性疼痛合并重度抑郁症（MDD）患者是否具有特定疗效及免疫效应。

方法

我们对抑郁和疼痛特异性针灸干预进行了一项受试者和评估者双盲、交叉、随机对照临床试验，并测量了慢性疼痛合并MDD患者的临床反应和促炎细胞因子。疼痛和抑郁的特定穴位按随机顺序使用，中间有洗脱期。47名患者入组并随机分为两组：（1）抑郁 - 疼痛组（23例患者，先接受抑郁特异性穴位治疗，洗脱后再接受疼痛特异性穴位治疗）和（2）疼痛 - 抑郁组（24例患者，顺序相反）。

结果

针对疼痛的疼痛特异性穴位降低简明疼痛量表评分的程度（-0.97 ± 1.69）并不比抑郁特异性穴位（-0.28 ± 1.88）显著更高；同样，抑郁特异性穴位改善汉密尔顿抑郁量表评分（-4.59 ± 6.02）的程度也不比疼痛特异性穴位（-6.69 ± 6.61）显著更好。疼痛特异性穴位改善贝克抑郁量表第二版评分（-6.74 ± 9.76）甚至优于抑郁特异性穴位（-1.92 ± 10.74）。抑郁特异性穴位降低与抑郁相关的白细胞介素（IL）-6水平（-1.24 ± 6.67）的程度并不比疼痛特异性穴位（-0.60 ± 4.36）显著更大。抑郁特异性穴位（-37.41 ± 194.49；-12.53 ± 54.68）和疼痛特异性穴位（-15.46 ± 87.56；-7.28 ± 27.86）之间IL-1β、肿瘤坏死因子（TNF）-α的变化水平也未达到显著差异。