Anodal Transcranial Direct Current Stimulation of the Motor Cortex Ameliorates Chronic Pain and Reduces Short Intracortical Inhibition
Anodal Transcranial Direct Current Stimulation of the Motor Cortex Ameliorates Chronic Pain and Reduces Short Intracortical Inhibition
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DOI：
10.1016/j.jpainsymman.2009.09.023
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发表时间：
2010-05-01
影响因子：
4.7
通讯作者：
Paulus, Walter
中科院分区：
文献类型：
--
作者：
Antal, Andrea;Terney, Daniella;Paulus, Walter
上下文在初级运动皮层（M1）上进行经颅直流电刺激（tDCS）的连续会话可能是治疗慢性疼痛的合适疗法，因为它可以调节受刺激和互连区域的神经活动。本研究采用主观（视觉模拟量表[VAS]）和客观（经颅磁刺激[TMS]测量的皮质兴奋性）测量研究了连续5天的阳极/假tDCS的镇痛作用。患有难治性慢性疼痛综合征（三叉神经痛、中风后疼痛综合征、背痛、纤维肌痛）的患者参与研究。由于本临床试验为探索性研究，统计分析采用探索性方法。采用交叉设计分析了12例接受阳极和假tDCS的患者。另外9名患者仅接受阳极或假刺激。采用随机、双盲设计，将tDCS应用于M1的手部区域，持续20分钟，1 mA，连续5天。在刺激前、刺激期间和刺激后1个月，每天使用VAS评分评估疼痛。M1兴奋性采用双脉冲TMS测定。与假手术tDCS相比，阳极tDCS导致VAS评分的改善更大，甚至在治疗后3 - 4周也很明显。减少皮质内抑制后，阳极刺激，表明皮质-皮质兴奋性的变化。没有患者出现严重的不良反应; 7例患者在阳极刺激后出现轻度头痛，6例患者在假刺激后出现轻度头痛。结果证实，在M1手部区域每天5次tDCS治疗可以对慢性疼痛患者产生持久的疼痛缓解。J Pain Symptom Manage 2010;39：890-903. (C)2010年美国癌症疼痛缓解委员会。爱思唯尔公司出版All rights reserved.
Context. Consecutive sessions of transcranial direct current stimulation (tDCS) over the primary motor cortex (M1) may be a suitable therapy to treat chronic pain, as it can modulate neural activities in the stimulated and interconnected regions.Objectives. The present study investigated the analgesic effect of five consecutive days of anodal/sham tDCS using subjective (visual analog scale [VAS]) and objective (cortical excitability measured by transcranial magnetic stimulation [TMS]) measurements.Methods. Patients with therapy-resistant chronic pain syndromes (trigeminal neuralgia, poststroke pain syndrome, back pain, fibromyalgia) participated. As this clinical trial was an exploratory study, statistical analyses implemented exploratory methods. Twelve patients, who underwent both anodal and sham tDCS, were analyzed using a crossover design. An additional nine patients had only anodal or sham stimulation. tDCS was applied over the hand area of the M1 for 20 minutes, at 1 mA for five consecutive days, using a randomized, double-blind design. Pain was assessed daily using a VAS rating for one month before, during, and one month post-stimulation. M1 excitability was determined using paired-pulse TMS.Results. Anodal tDCS led to a greater improvement in VAS ratings than sham tDCS, evident even three to four weeks post-treatment. Decreased intracortical inhibition was demonstrated after anodal stimulation, indicating changes in cortico-cortical excitability. No patient experienced severe adverse effects; seven patients suffered from light headache after anodal and six after sham stimulation.Conclusion. Results confirm that five daily sessions of tDCS over the hand area of the M1 can produce long-lasting pain relief in patients with chronic pain. J Pain Symptom Manage 2010;39:890-903. (C) 2010 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.