Winterholler Christine, Coura Maria Helena, Montoya Pedro
Research Institute of Health Sciences (IUNICS) & Balearic Islands Health Research Institute Foundation (IdISBa), University of Balearic Islands (UIB), Palma, Spain.
Universidade Nove de Julho, São Paulo, Brazil.
Front Pain Res (Lausanne). 2025 Aug 1;6:1593746. doi: 10.3389/fpain.2025.1593746. eCollection 2025.
Fibromyalgia syndrome (FMS) is linked to central sensitization and neuroplastic alterations that contribute to chronic pain, fatigue, cognitive, sleep, and affective disturbances. Conventional treatments offer limited benefit. Non-invasive transcranial electrical stimulation (tES), particularly transcranial direct current stimulation (tDCS), may modulate brain function and relieve symptoms, but findings remain inconsistent.
To systematically review and meta-analyze the effects of tES on clinical, neurophysiological, neuropsychological, and neurochemical outcomes in FMS.
Seven databases were searched for studies published between April 2013 and April 2023. Eligible designs included randomized controlled trials, cross-over, one-arm, and case studies involving adult FMS patients. Data extraction followed Cochrane Collaboration guidelines and used RevMan 6.6.0.
Anodal tDCS produced short- to mid-term reductions in pain and mood symptoms, especially when applied over M1 or DLPFC. Longer interventions and repeated sessions enhanced effects, though protocol heterogeneity limited comparability. Both subjective (VAS, NRS) and objective (QST) measures confirmed pain reduction. Cognitive improvements were inconsistent, and quality of life effects were limited. Neurophysiological and neurochemical changes suggested possible mechanisms, though findings varied. Study quality was mixed, with small sample sizes and methodological inconsistencies. Meta-analysis revealed statistically significant but small effects on pain (Hedges' < 0.2), with limited evidence on clinical relevance.
Anodal tDCS may offer short-term relief of pain and mood symptoms in FMS, potentially through modulation of cortical excitability and neuroplasticity. However, due to variability in findings and methodological limitations, its clinical relevance remains unclear. Future trials should use standardized protocols, assess long-term effects, and include clinically meaningful outcome measures.
https://www.crd.york.ac.uk/PROSPERO/view/CRD42023412332, PROSPERO CRD42023412332.
纤维肌痛综合征（FMS）与中枢敏化和神经可塑性改变有关，这些改变会导致慢性疼痛、疲劳、认知、睡眠和情感障碍。传统治疗的效果有限。非侵入性经颅电刺激（tES），特别是经颅直流电刺激（tDCS），可能会调节脑功能并缓解症状，但研究结果仍不一致。
系统评价和荟萃分析tES对FMS患者临床、神经生理、神经心理和神经化学结局的影响。
检索了7个数据库，查找2013年4月至2023年4月发表的研究。符合条件的设计包括随机对照试验、交叉试验、单臂试验和涉及成年FMS患者的病例研究。数据提取遵循Cochrane协作组指南，并使用RevMan 6.6.0。
阳极tDCS可在短期至中期减轻疼痛和情绪症状，尤其是应用于M1或背外侧前额叶皮质（DLPFC）时。更长时间的干预和重复疗程可增强效果，尽管方案异质性限制了可比性。主观（视觉模拟评分法、数字评定量表）和客观（定量感觉测试）测量均证实疼痛减轻。认知改善不一致，对生活质量的影响有限。神经生理和神经化学变化提示了可能的机制，尽管研究结果各不相同。研究质量参差不齐，样本量小且方法存在不一致性。荟萃分析显示对疼痛有统计学意义但较小的影响（Hedges'g<0.2），临床相关性证据有限。
阳极tDCS可能通过调节皮质兴奋性和神经可塑性，在短期内缓解FMS患者的疼痛和情绪症状。然而，由于研究结果的变异性和方法学局限性，其临床相关性仍不明确。未来的试验应使用标准化方案，评估长期效果，并纳入具有临床意义的结局指标。
https://www.crd.york.ac.uk/PROSPERO/view/CRD42023412332，PROSPERO CRD42023412332。
