Effects of Anodal Transcranial Direct Current Stimulation on Chronic Neuropathic Pain in Patients With Multiple Sclerosis
Effects of Anodal Transcranial Direct Current Stimulation on Chronic Neuropathic Pain in Patients With Multiple Sclerosis
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DOI：
10.1016/j.jpain.2009.08.011
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发表时间：
2010-05-01
期刊：
影响因子：
4
通讯作者：
Centonze, Diego
中科院分区：
文献类型：
--
作者：
Mori, Francesco;Codeca, Claudia;Centonze, Diego
多发性硬化症患者的神经病理性疼痛是常见的，并与日常生活活动的极大干扰有关。在本研究中，我们调查了阳极经颅直流电刺激（tDCS）是否可以有效地减少MS患者的中枢慢性疼痛。在一项随机、双盲、假对照研究中，患者在5天治疗期内接受假tDCS或真实的tDCS。使用疼痛视觉模拟量表（VAS）和简短麦吉尔问卷（SF-MPQ）测量疼痛。使用多发性硬化症生活质量-54量表（MSQoL-54）测量生活质量。还使用贝克抑郁量表（BDI）和焦虑VAS评估了抑郁症状和焦虑作为混杂因素。在基线、治疗结束后立即进行评价，并在3周随访期间每周进行一次评价。在运动皮质上进行阳极tDC 5（而非假tDC 5）后，通过疼痛VAS和麦吉尔问卷以及总体生活质量评估，疼痛显著改善。没有观察到抑郁或焦虑的变化。我们的研究结果表明，阳极tDCS是能够减少疼痛量表评分MS患者的中枢慢性疼痛，这种效果持续时间超过了刺激期，导致长期的临床效果。前景：本文提出了一种新的，非侵入性的治疗方法，慢性，中枢神经性疼痛的多发性硬化症，目前的常规药物反应不良。已知tDCS在健康受试者的刺激部位和连接区域引起神经元兴奋性的持久变化。这使我们假设疼痛减轻可能是慢性神经性疼痛发病机制中涉及的脑结构功能性可塑性变化的结果。(C)2010年美国疼痛协会
Neuropathic pain in patients with MS is frequent and is associated with a great interference with daily life activities. In the present study, we investigated whether anodal transcranial direct current stimulation (tDCS) may be effective in reducing central chronic pain in MS patients. Patients received sham tDCS or real tDCS in a 5-day period of treatment in a randomized, double blind, sham-controlled study. Pain was measured using visual analog scale (VAS) for pain and the short form McGill questionnaire (SF-MPQ). Quality of life was measured using the Multiple Sclerosis Quality of Life-54 scale (MSQoL-54). Depressive symptoms and anxiety were also evaluated as confounding factors using the Beck Depression Inventory (BDI) and VAS for anxiety. Evaluations were performed at baseline, immediately after the end of treatment, and once a week during a 3-week follow-up period. Following anodal but not sham tDC5 over the motor cortex, there was a significant pain improvement as assessed by VAS for pain and McGill questionnaire, and of overall quality of life. No depression or anxiety changes were observed. Our results show that anodal tDCS is able to reduce pain-scale scores in MS patients with central chronic pain and that this effect outlasts the period of stimulation, leading to long-lasting clinical effects.Perspective: This article presents a new, noninvasive therapeutic approach to chronic, central neuropathic pain in multiple sclerosis, poorly responsive to current conventional medications. tDCS is known to cause long-lasting changes of neuronal excitability at the site of stimulation and in the connected areas in healthy subjects. This led us to hypothesize that pain decrease may be the result of functional plastic changes in brain structures involved in the pathogenesis of chronic neuropathic pain. (C) 2010 by the American Pain Society