作用于不同部位的经颅直流电刺激对带状疱疹相关性疼痛患者睡眠质量的影响:一项随机、单盲、对照研究

Effects of transcranial direct current stimulation targeting different brain regions on sleep quality in patients with herpes zoster-associated pain: a randomized,? single-blind,? controlled study

摘要:

目的：探讨经颅直流电刺激（transcranial direct current stimulation，tDCS）刺激不同部位对带状疱疹相关性疼痛（zoster-associated pain，ZAP）患者睡眠质量的影响。方法：选取2024年12月-2025年4月在徐州医科大学附属医院疼痛科就诊的ZAP患者90例。在常规治疗的基础上，所有患者通过随机数字表法分为3组：A组（tDCS治疗一组；阳极位于F3，阴极位于Fpz），D组（tDCS治疗二组；阳极位于F3，阴极位于F4）和S组（tDCS假刺激组；阳极位于F3，阴极位于F4）。每组30例，均接受为期7天的tDCS治疗，每天刺激20分钟。分别采用匹兹堡睡眠质量指数（Pittsburgh sleep quality index，PSQI）、Fitbit Charge 2智能睡眠手环、数字评分量表（numerical rating scale, NRS）、汉密尔顿抑郁量表（Hamilton depression scale, HAMD）评估患者的睡眠质量、疼痛程度和情绪状态。结果：A组和D组患者PSQI评分在治疗结束后第4周和第8周时显著低于S组（P＜0.05），睡眠应答率高于S组（P＜0.05），而且患者的清醒时长和深睡眠时长均显著改善（P＜0.05）。同时，A组和D组患者的NRS评分在治疗结束后第8周时低于S组（P＜0.05）；HAMD评分在治疗结束后第4周和8周时均低于S组（P＜0.05）。但A组与D组患者在PSQI评分、NRS评分、HAMD评分，以及不同类型睡眠结构时长、睡眠应答率和缓解率等方面均无显著差异。结论：经过为期7天的tDCS辅助治疗，ZAP患者的睡眠质量、疼痛程度、抑郁状态均得到了显著改善。此外，阳极位于F3与阴极位于Fpz，和阳极位于F3与阴极位于F4在改善ZAP患者的睡眠方面没有显著差异。

Abstract:

Objective: To investigate the effects of transcranial direct current stimulation (tDCS) targeting different brain regions on sleep quality in patients with zoster-associated pain (ZAP). Methods: Ninety patients with zoster-associated pain (ZAP) who attended the Pain Management Department of the Affiliated Hospital of Xuzhou Medical University from December 2024 to April 2025 were enrolled. On the basis of conventional treatment, all patients were randomly divided into three groups using the random number table method: Group A (tDCS Group 1; anode placed at F3, cathode at Fpz), Group D (tDCS Group 2; anode placed at F3, cathode at F4), and Group S (sham tDCS Group; anode placed at F3, cathode at F4). Each group consisted of 30 patients, all of whom received tDCS treatment for 7 consecutive days, with 20 minutes of stimulation per day. The Pittsburgh Sleep Quality Index (PSQI), Fitbit Charge 2 smart sleep trackers, Numerical Rating Scale (NRS), and Hamilton Depression Scale (HAMD) were used to assess sleep quality, pain intensity, and emotional status, respectively. Results: Compared with Group S, Groups A and D had significantly lower PSQI scores, higher sleep response rates, and improved wake time and deep sleep duration at 4 and 8 weeks post-treatment (all P < 0.05). Additionally, NRS scores in Groups A and D were lower at 8 weeks (P < 0.05), and HAMD scores were reduced at both 4 and 8 weeks (P < 0.05). No significant differences were noted between Groups A and D in PSQI, NRS, HAMD scores, sleep structure durations, sleep response rate, or pain relief rate . Conclusion: After 7-day adjuvant tDCS treatment, sleep quality, pain intensity, and depressive status were significantly improved in ZAP patients. Additionally, no significant difference was observed in sleep improvement for ZAP patients between the electrode configurations of anode at F3 with cathode at Fpz and anode at F3 with cathode at F4.