双靶点经颅直流电刺激治疗头面部带状疱疹后神经痛的临床研究

Dual-Target Transcranial Direct Current Stimulation for Treating Craniofacial Postherpetic Neuralgia

摘要:

目的：探究双靶点经颅直流电刺激(transcranial direct current stimulation, tDCS)治疗头面部带状疱疹后神经痛(craniofacial postherpetic neuralgia, C-PHN)的疗效。方法：选取在首都医科大学宣武医院就诊的C-PHN患者40例,以1:1随机分为治疗组和对照组,治疗组采用初级运动皮层(M1)和前额叶背外侧部(DLPFC)双靶点tDCS交替刺激,对照组采用假刺激,两组均刺激10天。分别使用简明疼痛量表(brief pain inventory, BPI)、汉密尔顿抑郁量表(Hamilton depression scale, HAMD)和匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)评价两组患者刺激前、刺激后即刻和刺激后1个月的疼痛、抑郁和睡眠变化,分析影响疼痛变化的相关因素。结果：在第6次刺激后,治疗组和对照组的BPI评分开始出现显著差异(P＜0.05)。在第10次刺激后和刺激后1个月,治疗组的BPI评分、HAMD评分和PSQI评分均显著低于对照组(P＜0.05)。病程≤2月是影响患者疗效的保护因素(OR=30.881, P=0.047)。结论：M1和DLPFC双靶点tDCS是治疗C-PHN的有效方法,病程≤2月者治疗效果更佳。

Abstract:

Objective: To investigate the efficacy of dual-target transcranial direct current stimulation (tDCS) in treating craniofacial postherpetic neuralgia (C-PHN). Methods: Forty C-PHN patients from Xuanwu Hospital of Capital Medical University were selected and randomly divided into a treated group and a control group in a 1:1 ratio. The treated group received alternating stimulation of the primary motor cortex (M1) and dorsolateral prefrontal cortex (DLPFC) using dual-target tDCS, while the control group received sham stimulation. Both groups underwent 10 days of stimulation. The Brief Pain Inventory (BPI), Hamilton Depression Scale (HAMD), and Pittsburgh Sleep Quality Index (PSQI) were used to evaluate changes in pain, depression, and sleep before treatment, immediately after treatment, and 1-month post-treatment. Factors influencing pain changes were analyzed. Results: Significant differences in BPI scores between the treated and control groups emerged after the 6_th ^{stimulation session (}P < 0.05). After the 10_th stimulation session and 1-month post-treatment, the treated group had significantly lower BPI, HAMD, and PSQI scores compared to the control group (P < 0.05). A pain duration of ≤2 months was identified as a protective factor for treatment efficacy (OR=30.881, P=0.047). Conclusion: Dual-target tDCS of M1 and DLPFC is an effective treatment for C-PHN, with better outcomes for patients with a pain duration of ≤2 months.