Pain reduction in myofascial pain syndrome by anodal transcranial direct current stimulation combined with standard treatment: a randomized controlled study.
Pain reduction in myofascial pain syndrome by anodal transcranial direct current stimulation combined with standard treatment: a randomized controlled study.
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DOI：
10.1097/ajp.0000000000000069
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发表时间：
2014-12
期刊：
影响因子：
--
通讯作者：
Auvichayapat P
中科院分区：
文献类型：
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作者：
Sakrajai P;Janyacharoen T;Jensen MP;Sawanyawisuth K;Auvichayapat N;Tunkamnerdthai O;Keeratitanont K;Auvichayapat P
肩部肌筋膜疼痛综合征（MPS）是全球中年人群中最常见的疼痛问题之一。有证据表明，外周和中枢敏感化可能在肩关节MPS的发展和维持中起重要作用。鉴于先前的研究支持阳极经颅直流电刺激（tDCS）在难治性中枢性疼痛患者中调节疼痛相关脑活动的潜在疗效，我们假设阳极tDCS在初级运动皮层（M1）上应用时与标准治疗相结合，将比单独标准治疗更有效地减轻MPS患者的疼痛。研究参与者随机接受（1）标准治疗，连续5天在M1上进行1 mA阳极tDCS，持续20分钟，或（2）标准治疗加假tDCS。在治疗前和治疗后以及1周、2周、3周和4周随访时，测量疼痛强度、肩关节被动活动范围、镇痛药物使用情况和自我报告的身体功能。31例MPS患者入组。与分配到假tDCS条件的参与者相比，分配到活动tDCS条件的参与者报告了治疗前至治疗后疼痛强度的显著降低，并在治疗后1周维持，并且在1周随访时肩内收PROM的显著改善。与M1相比，连续5天的阳极tDCS联合标准治疗似乎可降低疼痛强度，并可能改善PROM，比单独标准治疗更快。需要进一步测试tDCS治疗MPS的疗效和作用持续时间。
Myofascial pain syndrome (MPS) in the shoulder is among the most prevalent pain problems in the middle-aged population worldwide. Evidence suggests that peripheral and central sensitization may play an important role in the development and maintenance of shoulder MPS. Given previous research supporting the potential efficacy of anodal transcranial direct current stimulation (tDCS) for modulating pain-related brain activity in individuals with refractory central pain, we hypothesized that anodal tDCS when applied over the primary motor cortex (M1) combined with standard treatment will be more effective for reducing pain in patients with MPS than standard treatment alone. Study participants were randomized to receive either (1) standard treatment with 5-consecutive days of 1 mA anodal tDCS over M1 for 20 min or (2) standard treatment plus sham tDCS. Measures of pain intensity, shoulder passive range of motion, analgesic medication use, and self-reported physical functioning were administered before treatment and again at post-treatment and 1-, 2-, 3-and 4-week follow-up. Thirty-one patients with MPS were enrolled. Participants assigned to the active tDCS condition reported significantly more pre- to post-treatment reductions in pain intensity that were maintained at 1-week post-treatment, and significant improvement in shoulder adduction PROM at 1-week follow-up than participants assigned to the sham tDCS condition. 5 consecutive days of anodal tDCS over M1 combined with standard treatment appears to reduce pain intensity, and may improve PROM, faster than standard treatment alone. Further tests of the efficacy and duration of effects of tDCS in the treatment of MPS are warranted.