The Immediate Effect of Transcranial Direct Current Stimulation (tDCS) Combined with TENS for Chronic Cervical Myofascial Pain - a Randomized, Sham-Controlled Study

經顱直流電刺激術結合經皮神經電刺激對慢性頸部肌筋膜疼痛之立即效果

葉怡嘉(Yi-Chia Yeh) ； 郭旻芳(Min-Fang Kuo) ； 吳炎村(Yen-Chun Wu)

《童綜合醫學雜誌》 15卷S期 (2021/09) Pp. 24-30

https://doi.org/10.3966/20713592202109150S004

摘要

Objective: We sought to clarify whether a combination treatment of transcranial direct current stimulation (tDCS) and transcutaneous electrical nerve stimulation (TENS) could result in greater pain relief for patients with chronic cervical myofascial pain syndrome. Methods: This study was a randomized, sham-controlled, crossover clinical trial. Ten patients with chronic cervical myofascial pain randomly received each of active tDCS/active TENS, active tDCS/sham TENS, and sham tDCS/active TENS stimulation. Visual analog scale and pressure pain threshold scores were recorded immediately before and after each treatment by a blinded evaluator. Results: The three treatment approaches all showed significant pain reduction effects (p = 0.00) compared with the baseline scores. The pain reduction percentage in tDCS/TENS, tDCS/sham TENS, sham tDCS/TENS were 35.41%, 30.27%, and 26.64%, respectively. However, none of the groups reached statistical significance, although a greater pain reduction was observed in the tDCS/TENS group (p = 0.543). No significant differences in trigger point sensitivity were noted in all treatment groups (p = 0.934). The results suggest that both tDCS and TENS increased the pain threshold without changing the trigger point activity directly, thus limiting the therapeutic effect of the combined treatment. Conclusions: The results of this study suggest that tDCS combined with TENS or tDCS alone demonstrated the same therapeutic effect as TENS, but neither demonstrated superior effects.

關鍵字

transcranial direct current stimulation ； transcutaneous electrical nerve stimulation ； chronic myofascial pain

並列摘要

在近年來的研究中，發現經顱直流電刺激術合併經皮電刺激對於慢性頑固性神經疼痛患者有減輕疼痛的效果，並且比單獨使用經顱直流電刺激術或是對照組有更佳的止痛效果。我們在本研究中，假設此種治療方式對慢性頸部肌筋膜疼痛症，相較於單獨使用經顱直流電刺激術或是經皮電刺激治療，會有更佳的治療效果。本研究採用隨機控制及交叉設計方法。收案十名慢性斜方肌肌筋膜疼痛患者，每個人都接受三種不同的治療方式，經顱直流電刺激術（tDCS）結合經皮神經電刺激（TENS）（tDCS/TENS, tDCS/sham TENS, sham tDCS/TENS），在治療前後記錄視覺類比分數（visual analogue scale）及壓痛閾值pressure pain threshold）。研究結果顯示本研究發現三種治療方式的疼痛減輕百分比都有達到顯著的意義，分別為tDCS/TENS組（35.41%），tDCS/sham TENS組（30.27%），sham tDCS/TENS組（26.64%）。但三組之間比較並沒有統計上的差異（p= 0.543）。在肌筋膜疼痛點敏感度（trigger point sensitivity）上，三組間沒有統計上的差異（p=0.934）。此結果可能代表這三種治療都提高了疼痛閾值，但因沒有直接改變肌筋膜疼痛點的活性，造成合併兩種療法並未呈現更佳的的療效。

並列關鍵字

經顱直流電刺激 ； 經皮電刺激 ； 慢性肌筋膜疼痛