Large Treatment Effect With Extended Home-Based Transcranial Direct Current Stimulation Over Dorsolateral Prefrontal Cortex in Fibromyalgia: A Proof of Concept Sham-Randomized Clinical Study
Large Treatment Effect With Extended Home-Based Transcranial Direct Current Stimulation Over Dorsolateral Prefrontal Cortex in Fibromyalgia: A Proof of Concept Sham-Randomized Clinical Study
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DOI：
10.1016/j.jpain.2019.06.013
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发表时间：
2020-01-01
期刊：
影响因子：
4
通讯作者：
Caumo, Wolnei
中科院分区：
文献类型：
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作者：
Brietzke, Aline P.;Zortea, Maxciel;Caumo, Wolnei
这项随机、双盲对照试验检验了60次家庭阳极！（a）在背外侧前额叶皮层（DLPFC）上的经颅直流电刺激（tDCS）将比在家的假tDCS更好地改善广泛的疼痛和与疼痛相关的残疾。在现场培训后，使用专门开发的器械对左侧DLPFC进行阳极tDCS（2 mA，持续30分钟）自我给药。将20名18至65岁的女性随机分为2组[活性-（a）-tDCS（n = 10）或假-（s）-tDCS（n = 10）]。事后分析显示，在前20次a-tDCS治疗后，累积疼痛评分降低了45.65% [活性tDCS与假tDCS分别为7.25（1.43）vs 3.94（1.14）]。60次治疗后，在12周的评估期间，活动组的疼痛评分降低了62.06%[视觉模拟量表降低，7.25（1.43）至2.75（.85）]，而s-tDCS组为24.92%，[平均值（SD）7.10（1.81）vs 5.33（.90）]。它降低了55%使用止痛药的风险。脑源性神经营养因子的血清水平越高，治疗期间疼痛评分的下降幅度越大。（1）延长治疗期（60届会议，迄今为止，测试的最大数量的tDCS会话）用于纤维肌痛引起大的疼痛减少（大效应量为1.59）和2）支持家庭tDCS作为干预方法的可行性; 3）提供关于DLPFC治疗纤维肌痛目标的额外数据。最后，我们的研究结果还强调，脑源性神经营养因子，以指数神经可塑性可能是一个有价值的预测的tDCS对疼痛评分下降的影响在整个治疗。(C)2020年美国疼痛研究协会。爱思唯尔公司出版All rights reserved.
This randomized, double-blind controlled trial tested the hypothesis that 60 sessions of home-based anode! (a)-transcranial direct current stimulation (tDCS) over dorsolateral prefrontal cortex (DLPFC) would be better than home-based sham-tDCS to improve the widespread pain and the disability-related to pain. The anodal-tDCS (2 mA for 30 minutes) over the left DLPFC was self-administered with a specially developed device following in-person training. Twenty women, 18 to 65 years old were randomized into 2 groups [active-(a)-tDCS (n = 10) or sham-(s)-tDCS (n = 10)]. Post hoc analysis revealed that after the first 20 sessions of a-tDCS, the cumulative pain scores reduced by 45.65% [7.25 (1.43) vs 3.94 (1.14), active vs sham tDCS, respectively]. After 60 sessions, during the 12-week assessment, pain scores reduced by 62.06% in the actively group [visual analogue scale reduction, 7.25 (1.43) to 2.75 (.85)] compared to 24.92% in the s-tDCS group, [mean (SD) 7.10 (1.81) vs 5.33 (.90)], respectively. It reduced the risk for analgesic use in 55%. Higher serum levels of the brain-derived neurotrophic factor predicted higher decreases on the pain scores across of treatment.Perspective: These findings bring 3 important insights: 1) show that an extended period of treatment (60 sessions, to date the largest number of tDCS sessions tested) for fibromyalgia induces large pain decreases (a large effect size of 1.59) and 2) support the feasibility of home-based tDCS as a method of intervention; 3) provide additional data on DLPFC target for the treatment of fibromyalgia. Finally, our findings also highlight that brain-derived neurotrophic factor to index neuroplasticity may be a valuable predictor of the tDCS effect on pain scores decreases across the treatment. (C) 2020 U.S. Association for the Study of Pain. Published by Elsevier Inc. All rights reserved.