双靶点经颅直流电刺激调控短时和持续性疼痛：一项双盲、随机对照研究

doi:10.3724/SP.J.1041.2024.01313

摘要/Abstract

摘要：

当前经颅直流电刺激(transcranial direct current stimulation, tDCS)的镇痛效果不佳且存在较大的个体差异, 可能与疼痛神经网络的复杂性及当前tDCS调控靶点单一有关。为提高tDCS缓解疼痛的效果, 本研究使用双盲、随机对照的实验设计, 采用双靶点tDCS技术, 对背外侧前额叶皮层(dorsolateral prefrontal cortex, DLPFC)和初级运动皮层(primary motor cortex, M1)进行同步刺激, 通过调节DLPFC和M1所属不同的疼痛传导通路, 探究双靶点tDCS的镇痛效果及优势。结果表明, 与假刺激对照组相比, 双靶点tDCS组对中等强度短时热痛、辣椒素诱发的持续性疼痛以及压痛阈限具有显著的调控效应, 且调控效应优于单靶点tDCS组。同时, 双靶点tDCS的镇痛效应与被试的疼痛恐惧特质显著相关, 即被试疼痛恐惧量表评分越高, 镇痛效果越好。综上, 本研究揭示了双靶点tDCS对短时热痛和持续性疼痛的稳定镇痛效果, 支持了疼痛神经网络的并行处理理论, 也为双靶点tDCS在疼痛治疗中的潜在应用提供了科学依据。

关键词: 经颅直流电刺激, 双靶点tDCS, 镇痛, 背外侧前额叶皮层, 初级运动皮层

Abstract:

Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technique known for its reversibility, high safety, and patient compliance. It holds promise as a potential non-pharmacological method for analgesia. Previous studies have primarily focused on applying tDCS to the dorsolateral prefrontal cortex (DLPFC) or the primary motor cortex (M1) for pain modulation. However, the analgesic effect of tDCS has shown unsatisfactory results with significant variation among individuals, possibly due to the complexity of the pain neural network and the limited targeting of previous tDCS interventions. To improve the efficacy of tDCS in pain relief, the present study used dual-target tDCS technology to simultaneously modulate the DLPFC and M1, with the aim of investigating the analgesic effects and advantages of this approach.

In Experiment 1, a total of 80 healthy participants were double-blind, randomly allocated to receive either lDLPFC+rM1-tDCS, lDLPFC-tDCS, rM1-tDCS, or Sham-tDCS. The perception of transient pain induced by thermal stimulation and pressure pain thresholds were assessed before and after tDCS application. Dual-target tDCS demonstrated a significant analgesic effect on moderate-intensity transient pain and pressure pain thresholds, surpassing the effects observed in the lDLPFC-tDCS or rM1-tDCS groups. Furthermore, we found a significant correlation between the analgesic effects of dual-target tDCS on transient pain and participants' pain fear trait. Specifically, the higher the scores on the participants' fear of pain questionnaire, the greater the analgesic effects.

In Experiment 2, a total of 26 participants double-blinded underwent three distinct intervention conditions: lDLPFC+rM1-tDCS (Dual-target), lDLPFC or rM1-tDCS (Single-target), and Sham. The sequence of these conditions was randomized, with a minimum interval of seven days between sessions. The perception of sustained pain induced by capsaicin was assessed during tDCS modulation and 30 minutes post-stimulation. During and after the tDCS modulation, the pain intensity scores in the dual-target tDCS group were significantly lower than those in the sham stimulation group and the single-target tDCS group.

Data from Experiments 1 and 2 demonstrated that dual-target tDCS exhibited a significant analgesic effect on transient pain, sustained pain, and pressure pain thresholds. This analgesic effect was superior to that observed in the single-target tDCS group, supporting the theory of multi-pathway parallel processing in the pain neural network and providing evidence for the potential application of dual-target tDCS in pain treatment.

Key words: transcranial direct current stimulation, dual-target tDCS, analgesic, dorsolateral prefrontal cortex, primary motor cortex.

中图分类号:

B849 R395

邱义, 常香玉, 涂毅恒. (2024). 双靶点经颅直流电刺激调控短时和持续性疼痛：一项双盲、随机对照研究. 心理学报, 56(10), 1313-1327.

QIU Yi, CHANG Xiang-Yu, TU Yi-Heng. (2024). Analgesic effect of dual-target transcranial direct current stimulation on transient pain and sustained pain: A double-blind, randomized controlled study. Acta Psychologica Sinica, 56(10), 1313-1327.

图/表 10

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变量	lDLPFC+rM1 (n = 21)	LDLPFC (n = 20)	rM1 (n = 20)	假刺激组 (n = 19)	统计指标
变量	lDLPFC+rM1 (n = 21)	LDLPFC (n = 20)	rM1 (n = 20)	假刺激组 (n = 19)	F/χ²	p_-fdr
年龄	23.71 ± 0.58	24.10 ± 0.60	22.30 ± 0.60	24.50 ± 0.61	F(3, 76) = 2.66	0.054
性别(女/男)	10/11	11/9	10/10	9/10	χ²(3) = 0.3	0.960
MP刺激强度(℃)	46.00 ± 0.33	45.88 ± 0.34	45.70 ± 0.34	45.92 ± 0.35	F(3, 76) = 0.14	0.935
HP刺激强度(℃)	47.71 ± 0.28	47.30 ± 0.28	47.45 ± 0.28	47.82 ± 0.29	F(3, 76) = 0.69	0.562
疼痛恐惧量表	91.24 ± 3.31	95.40 ± 3.39	100.70 ± 3.39	95.11 ± 3.48	F(3, 76) = 1.34	0.268
疼痛灾难化量表	24.47 ± 2.09	24.60 ± 2.14	24.95 ± 2.14	25.21 ± 2.20	F(3, 76) = 0.02	0.995
疼痛敏感性量表	3.20 ± 0.28	3.81 ± 0.29	3.41 ± 0.29	3.49 ± 0.29	F(3, 76) = 0.81	0.495
状态焦虑量表	33.95 ± 1.82	36.35 ± 1.87	32.15 ± 1.87	36.00 ± 1.92	F(3, 76) = 1.09	0.360
负性情绪量表 (后测−前测)	1.19 ± 1.13	−0.30 ± 1.15	−1.15 ± 1.15	−1.12 ± 1.18	F(3, 76) = 0.9	0.436
正性情绪量表 (后测−前测)	−4.00 ± 1.09	−3.45 ± 1.12	−3.00 ± 1.12	−2.74 ± 1.15	F(3, 76) = 0.25	0.863
tDCS感觉总分	16.86 ± 0.75	17.05 ± 0.77	17.55 ± 0.77	19.11 ± 0.78	F(3, 76) = 1.71	0.171

变量	lDLPFC+rM1 (n = 21)	LDLPFC (n = 20)	rM1 (n = 20)	假刺激组 (n = 19)	统计指标
变量	lDLPFC+rM1 (n = 21)	LDLPFC (n = 20)	rM1 (n = 20)	假刺激组 (n = 19)	F/χ²	p_-fdr
年龄	23.71 ± 0.58	24.10 ± 0.60	22.30 ± 0.60	24.50 ± 0.61	F(3, 76) = 2.66	0.054
性别(女/男)	10/11	11/9	10/10	9/10	χ²(3) = 0.3	0.960
MP刺激强度(℃)	46.00 ± 0.33	45.88 ± 0.34	45.70 ± 0.34	45.92 ± 0.35	F(3, 76) = 0.14	0.935
HP刺激强度(℃)	47.71 ± 0.28	47.30 ± 0.28	47.45 ± 0.28	47.82 ± 0.29	F(3, 76) = 0.69	0.562
疼痛恐惧量表	91.24 ± 3.31	95.40 ± 3.39	100.70 ± 3.39	95.11 ± 3.48	F(3, 76) = 1.34	0.268
疼痛灾难化量表	24.47 ± 2.09	24.60 ± 2.14	24.95 ± 2.14	25.21 ± 2.20	F(3, 76) = 0.02	0.995
疼痛敏感性量表	3.20 ± 0.28	3.81 ± 0.29	3.41 ± 0.29	3.49 ± 0.29	F(3, 76) = 0.81	0.495
状态焦虑量表	33.95 ± 1.82	36.35 ± 1.87	32.15 ± 1.87	36.00 ± 1.92	F(3, 76) = 1.09	0.360
负性情绪量表 (后测−前测)	1.19 ± 1.13	−0.30 ± 1.15	−1.15 ± 1.15	−1.12 ± 1.18	F(3, 76) = 0.9	0.436
正性情绪量表 (后测−前测)	−4.00 ± 1.09	−3.45 ± 1.12	−3.00 ± 1.12	−2.74 ± 1.15	F(3, 76) = 0.25	0.863
tDCS感觉总分	16.86 ± 0.75	17.05 ± 0.77	17.55 ± 0.77	19.11 ± 0.78	F(3, 76) = 1.71	0.171

变量	双靶点tDCS组	单靶点tDCS组	假刺激组	统计指标
变量	双靶点tDCS组	单靶点tDCS组	假刺激组	F	p_-fdr
状态焦虑量表	37.77 ± 1.64	36.46 ± 1.65	36.19 ± 1.79	F(2, 50) = 1.25	0.294
负性情绪量表(后测−前测)	−0.81 ± 0.40	0.19 ± 0.62	−0.39 ± 0.62	F(2, 50) = 0.97	0.388
正性情绪量表(后测−前测)	−2.08 ± 0.45	−1.73 ± 0.54	−1.62 ± 0.96	F(2, 50) = 0.17	0.845
tDCS感觉总分	16.54 ± 0.68	16.35 ± 0.54	17.31 ± 0.57	F(2, 50) = 1.58	0.215

变量	双靶点tDCS组	单靶点tDCS组	假刺激组	统计指标
变量	双靶点tDCS组	单靶点tDCS组	假刺激组	F	p_-fdr
状态焦虑量表	37.77 ± 1.64	36.46 ± 1.65	36.19 ± 1.79	F(2, 50) = 1.25	0.294
负性情绪量表(后测−前测)	−0.81 ± 0.40	0.19 ± 0.62	−0.39 ± 0.62	F(2, 50) = 0.97	0.388
正性情绪量表(后测−前测)	−2.08 ± 0.45	−1.73 ± 0.54	−1.62 ± 0.96	F(2, 50) = 0.17	0.845
tDCS感觉总分	16.54 ± 0.68	16.35 ± 0.54	17.31 ± 0.57	F(2, 50) = 1.58	0.215

	刚刚感觉到痛									最严重的疼痛
1. 想象你的小腿很重地撞在一个硬的边缘上, 例如：玻璃茶桌的边缘。你会觉得有多痛?	1	2	3	4	5	6	7	8	9	10
2. 想象你的舌头被很热的饮料烫到。	1	2	3	4	5	6	7	8	9	10
3. 想象你的肌肉因运动而有轻微的酸痛。	1	2	3	4	5	6	7	8	9	10
4. 想象你的手指被抽屉夹到。	1	2	3	4	5	6	7	8	9	10
5. 想象你用温水淋浴。	1	2	3	4	5	6	7	8	9	10
6. 想象你的肩膀被轻度晒伤。	1	2	3	4	5	6	7	8	9	10
7. 想象你从自行车上摔下擦伤了膝盖。	1	2	3	4	5	6	7	8	9	10
8. 想象你吃东西的时候意外大力咬到舌头或脸颊。	1	2	3	4	5	6	7	8	9	10
9. 想象你赤脚走过清凉的瓷砖地板。	1	2	3	4	5	6	7	8	9	10
10. 想象你的手指被割了个小伤口, 而且无意中把盐撒到伤口上。	1	2	3	4	5	6	7	8	9	10
11. 想象月季花刺扎到你的手指尖。	1	2	3	4	5	6	7	8	9	10
12. 想象你赤着双手拿冰袋几分钟。	1	2	3	4	5	6	7	8	9	10
13. 想象你和一个正常手力的人握手。	1	2	3	4	5	6	7	8	9	10
14. 想象你和一个手力很强的人握手。	1	2	3	4	5	6	7	8	9	10
15. 想象你端起火锅时不小心抓到了跟锅一样发烫的锅耳。	1	2	3	4	5	6	7	8	9	10
16. 想象你穿凉鞋时被穿厚重靴子的人踩到。	1	2	3	4	5	6	7	8	9	10
17. 想象你手肘的麻筋撞到桌子的边缘。	1	2	3	4	5	6	7	8	9	10