Hodaj Hasan, Payen Jean-Francois, Hodaj Enkelejda, Sorel Marc, Dumolard Anne, Vercueil Laurent, Delon-Martin Chantal, Lefaucheur Jean-Pascal
Centre de la Douleur, Pôle Anesthésie Réanimation, CHU Grenoble Alpes, 38000 Grenoble, France.
Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France.
Brain Commun. 2023 Jul 1;5(4):fcad191. doi: 10.1093/braincomms/fcad191. eCollection 2023.
The aim of the present study was to compare the analgesic effect of motor cortex stimulation using high-frequency repetitive transcranial magnetic stimulation or transcranial direct current stimulation and transcutaneous spinal direct current stimulation in patients with complex regional pain syndrome. Thirty-three patients with complex regional pain syndrome were randomized to one of the three treatment groups (repetitive transcranial magnetic stimulation, = 11; transcranial direct current stimulation, = 10; transcutaneous spinal direct current stimulation, = 12) and received a series of 12 sessions of stimulation for 3 weeks (induction phase) and 11 sessions for 4 months (maintenance therapy). The primary end-point was the mean pain intensity assessed weekly with a visual numerical scale during the month prior to treatment (baseline), the 5-month stimulation period and 1 month after the treatment. The weekly visual numerical scale pain score was significantly reduced at all time points compared to baseline in the transcutaneous spinal direct current stimulation group, at the last two time points in the repetitive transcranial magnetic stimulation group (end of the 5-month stimulation period and 1 month later), but at no time point in the transcranial direct current stimulation group. A significant pain relief was observed at the end of induction phase using transcutaneous spinal direct current stimulation compared to repetitive transcranial magnetic stimulation ( = 0.008) and to transcranial direct current stimulation ( = 0.003). In this trial, transcutaneous spinal direct current stimulation was more efficient to relieve pain in patients with complex regional pain syndrome compared to motor cortex stimulation techniques (repetitive transcranial magnetic stimulation, transcranial direct current stimulation). This efficacy was found during the induction phase and was maintained thereafter. This study warrants further investigation to confirm the potentiality of transcutaneous spinal direct current stimulation as a therapeutic option in complex regional pain syndrome.
本研究的目的是比较高频重复经颅磁刺激或经颅直流电刺激与经皮脊髓直流电刺激对复杂性区域疼痛综合征患者的镇痛效果。33例复杂性区域疼痛综合征患者被随机分为三个治疗组之一（重复经颅磁刺激组，n = 11；经颅直流电刺激组，n = 10；经皮脊髓直流电刺激组，n = 12），并接受一系列12次刺激，为期3周（诱导期），以及11次刺激，为期4个月（维持治疗）。主要终点是在治疗前1个月（基线）、5个月刺激期和治疗后1个月期间，每周用视觉数字量表评估的平均疼痛强度。与基线相比，经皮脊髓直流电刺激组在所有时间点的每周视觉数字量表疼痛评分均显著降低，重复经颅磁刺激组在最后两个时间点（5个月刺激期结束时和1个月后）显著降低，但经颅直流电刺激组在任何时间点均未降低。与重复经颅磁刺激（P = 0.008）和经颅直流电刺激（P = 0.003）相比，经皮脊髓直流电刺激在诱导期结束时观察到显著的疼痛缓解。在本试验中，与运动皮层刺激技术（重复经颅磁刺激、经颅直流电刺激）相比，经皮脊髓直流电刺激在缓解复杂性区域疼痛综合征患者的疼痛方面更有效。这种疗效在诱导期发现，并在此后得以维持。本研究值得进一步调查，以确认经皮脊髓直流电刺激作为复杂性区域疼痛综合征治疗选择的潜力。
