靶向边缘系统自我神经调节以减轻纤维肌痛中的中枢敏化症状

Targeted limbic self-neuromodulation for alleviating central sensitization symptoms in fibromyalgia.

作者信息

Or-Borichev Ayelet, Lerner Yulia, Hamrani Yael, Gurevitch Guy, Mor Netali, Doron Maayan, Sarna Noam, Ablin Jacob N, Hendler Talma, Sharon Haggai

机构信息

Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv, 6423906, Israel.

Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, 6997801, Israel.

出版信息

BMC Med. 2025 May 28;23(1):304. doi: 10.1186/s12916-025-04138-3.

DOI:10.1186/s12916-025-04138-3

PMID:40437546

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12121213/

Abstract

BACKGROUND

Fibromyalgia (FM), involving somatic, cognitive, and affective domains is often regarded as a hallmark central sensitization syndrome. Despite limited current therapeutic options, emerging understanding of its neural underpinnings offers the potential of applying novel neuromodulation strategies. Specifically, limbic dysregulation underlying abnormalities in pain modulation and somatic-affective processing, has been shown to play a key role in FM. Here, we assessed the long-term efficacy of targeted limbic self-neuromodulation for improving clinical disease burden in FM.

METHODS

Forty-seven patients with FM participated in a double-blind, randomized, dual-control study employing a novel specialized neurofeedback probe representing amygdala activity. Patients underwent 10 sessions of either genuine neurofeedback training (NFT = 21), or sham neurofeedback training (NFS = 13), or treatment as usual (TAU = 13). Disease severity and symptom burden were assessed using the Symptom Severity Score (SSS), along with other questionnaires administered before and after treatment. A clinical follow-up was performed 10-12 months post-intervention.

RESULTS

NFT led to a significant immediate and long-term reduction in the SSS (F = 7.32, p = 0.00, ηp2 = 0.27) and the Fibromyalgia Impact Questionnaire (FIQ) (F = 9.85, p = 0.00, ηp2 = 0.33), alongside multidomain short- and long-term clinical benefits. NFS resulted in a long-term reduction in pain but did not affect other disease measures or overall disease burden. The TAU group showed no clinical improvements.

CONCLUSIONS

Our findings support the intimate involvement of limbic brain areas in the pathophysiology of FM and suggest that targeted neuromodulation offers a novel, mechanism-based approach for managing multidomain symptoms in FM.

TRIAL REGISTRATION

This study was preregistered with the National Institutes of Health (NIH).

REGISTRATION NUMBER

NCT02146495. Name of trial registry: Targeted Limbic Self-modulation as a Potential Treatment for Patients Suffering From Fibromyalgia https://clinicaltrials.gov/study/NCT02146495 .

摘要

背景

纤维肌痛（FM）涉及躯体、认知和情感领域，常被视为典型的中枢敏化综合征。尽管目前的治疗选择有限，但对其神经基础的新认识为应用新型神经调节策略提供了可能。具体而言，疼痛调节和躯体-情感处理异常背后的边缘系统失调已被证明在FM中起关键作用。在此，我们评估了靶向边缘系统自我神经调节对改善FM临床疾病负担的长期疗效。

方法

47例FM患者参与了一项双盲、随机、双对照研究，采用一种代表杏仁核活动的新型专用神经反馈探针。患者接受10次真正的神经反馈训练（NFT = 21）、假神经反馈训练（NFS = 13）或常规治疗（TAU = 13）。使用症状严重程度评分（SSS）以及治疗前后发放的其他问卷评估疾病严重程度和症状负担。干预后10 - 12个月进行临床随访。

结果

NFT导致SSS（F = 7.32，p = 0.00，ηp2 = 0.27）和纤维肌痛影响问卷（FIQ）（F = 9.85，p = 0.00，ηp2 = 0.33）显著即时和长期降低，同时伴有多领域短期和长期临床益处。NFS导致疼痛长期减轻，但不影响其他疾病指标或总体疾病负担。TAU组未显示临床改善。