Effectiveness of TENS on Fibromyalgia

TENS 对纤维肌痛的疗效

• 批准号: 8023139
• 负责人: KATHLEEN A SLUKA
• 金额: $ 16.24万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-01-17 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8023139
• 关键词: American; Articular Range of Motion; Basic Science; Brain Stem; Brief Pain Inventory; Chronic; Clinical; Clinical Trials; Degenerative polyarthritis; Effectiveness; Electric Stimulation; Fatigue; Fibromyalgia; Frequencies; Fright; Future; Health Professional; Home environment; Individual; Intervention; Laboratories; Measures; Midbrain structure; Modality; Movement; Muscle; Musculoskeletal Pain; Neuraxis; Neurons; Nociception; Outcome; Outcome Measure; Pain; Pain Threshold; Pain management; Participant; Pathway interactions; Patients; Persons; Physical Function; Physiological; Physiology; Placebo Control; Placebos; Population; Postoperative Pain; Process; Quality of life; Questionnaires; Rest; Rheumatology; Sensory; Skin; Social Work; Spinal; Spinal Cord; Symptoms; Syndrome; Testing; Transcutaneous Electric Nerve Stimulation; Visual; Walking; Work; analog; chronic pain; college; daily functioning; design; diffuse noxious inhibitory control; effective therapy; foot; improved functioning; innovation; pain inhibition; patient population; pressure

DESCRIPTION (provided by applicant): Fibromyalgia is a chronic pain condition that is characterized by widespread pain. Pain associated with fibromyalgia interferes with daily function, work, and social activities resulting in a decreased quality of life. In addition people with fibromyalgia have a significant amount fatigue and a fear of movement. The cause of fibromyalgia is unknown, but people with fibromyalgia show enhanced excitability of pain neurons in central nervous system and reduced pain inhibition. One of the main treatments for patients with fibromyalgia must, therefore, focus on pain relief to allow the person to function more independently both at home and at work. Transcutaneous electrical nerve stimulation (TENS) is a modality used by health professionals that delivers electrical stimulation through the skin for pain control. Basic science studies, from the PIs laboratory, show that TENS activates descending pain inhibitory pathways to inhibit excitability of pain neurons. Thus, the ideal patient population for the treatment of TENS would be one in which there is enhanced central excitability and reduced inhibition; fibromyalgia is such a condition. Although TENS is effective for several pain conditions such as osteoarthritis, chronic musculoskeletal pain, and postoperative pain [5;20;39], its effectiveness in treatment of people with fibromyalgia is virtually unknown. Furthermore, there is a general thought among clinicians that since fibromyalgia pain is widespread, TENS would be ineffective in this population. Thus, TENS may decrease pain associated with fibromyalgia by increasing central inhibition and decreasing central excitability. This decrease in pain is expected to increase function and improve quality of life. We hypothesize that application of TENS to patients with fibromyalgia will reduce resting and movement-related pain and reduce central excitability by restoring diffuse noxious inhibitory controls (DNIC), and that this decrease in pain and/or central excitability will reduce fatigue and fear of movement, thereby improving function and quality of life. We will test this hypothesis through 3 Specific Aims. Aim #1: The primary aim of the study is to test the effectiveness of the long-term use of TENS on resting and movement-related pain in people with fibromyalgia with random assignment to three treatments: no treatment control, placebo TENS and active TENS. Aim #2: A secondary aim will test if pain reduction by TENS results in a concomitant decrease in fatigue and fear of movement, and an increase in function and quality of life. Aim #3 will determine if active TENS alters pain processing in people with fibromyalgia and if improvement in clinical symptoms correlates with normalization of pain processing physiology. This innovative study will be the first to examine the effectiveness of TENS in people with fibromyalgia using multiple outcomes including pain at rest and during movement, as well as function, fatigue, and quality of life in individuals with fibromyalgia. Using multiple measures will give us a better understanding of appropriate measures for future clinical trials of non-pharmacological treatments, and for treatment of pain in people with fibromyalgia.

描述（由申请人提供）：纤维肌痛是一种以广泛性疼痛为特征的慢性疼痛。与纤维肌痛相关的疼痛会干扰日常功能、工作和社交活动，导致生活质量下降。此外，患有纤维肌痛的人有明显的疲劳和害怕运动。纤维肌痛的病因尚不清楚，但纤维肌痛患者表现为中枢神经系统疼痛神经元兴奋性增强，疼痛抑制能力降低。因此，纤维肌痛患者的主要治疗方法之一必须集中在减轻疼痛上，以使患者在家庭和工作中都能更独立地工作。经皮神经电刺激（TENS）是卫生专业人员使用的一种方式，通过皮肤提供电刺激来控制疼痛。来自pi实验室的基础科学研究表明，TENS激活下行疼痛抑制通路，抑制疼痛神经元的兴奋性。因此，治疗TENS的理想患者群体应该是中枢兴奋性增强、抑制性降低的人群；纤维肌痛就是这样一种情况。尽管TENS对骨关节炎、慢性肌肉骨骼疼痛和术后疼痛等几种疼痛状况有效[5;20；[39]，其在治疗纤维肌痛患者中的有效性几乎是未知的。此外，临床医生普遍认为，由于纤维肌痛疼痛普遍存在，因此TENS在这一人群中无效。因此，TENS可能通过增加中枢抑制和降低中枢兴奋性来减轻纤维肌痛相关的疼痛。这种疼痛的减少有望增加功能和改善生活质量。我们假设将TENS应用于纤维肌痛患者将通过恢复弥漫性有害抑制控制（DNIC）来减少休息和运动相关的疼痛和中枢兴奋性，并且这种疼痛和/或中枢兴奋性的减少将减少疲劳和运动恐惧，从而改善功能和生活质量。我们将通过3个具体目标来检验这一假设。目的1：该研究的主要目的是测试长期使用TENS对纤维肌痛患者静息和运动相关疼痛的有效性，随机分配到三种治疗方法：无治疗对照，安慰剂TENS和主动TENS。目标2：第二个目标是测试通过TENS减轻疼痛是否会导致疲劳和运动恐惧的减少，以及功能和生活质量的提高。目的3将确定活跃的TENS是否会改变纤维肌痛患者的疼痛处理，以及临床症状的改善是否与疼痛处理生理学的正常化相关。这项创新研究将首次检验TENS对纤维肌痛患者的有效性，使用多种结果，包括休息和运动时的疼痛，以及纤维肌痛患者的功能、疲劳和生活质量。使用多种措施将使我们更好地了解未来非药物治疗的临床试验的适当措施，以及治疗纤维肌痛患者的疼痛。

项目成果

Transcutaneous electrical nerve stimulation reduces pain, fatigue and hyperalgesia while restoring central inhibition in primary fibromyalgia.

• DOI: 10.1016/j.pain.2013.07.043
• 发表时间: 2013-11
• 期刊: Pain
• 影响因子: 7.4
• 作者: Dailey DL;Rakel BA;Vance CGT;Liebano RE;Amrit AS;Bush HM;Lee KS;Lee JE;Sluka KA
• 通讯作者: Sluka KA