تأثیر یک جلسه تحریک فراجمجمه‌ای مغز با جریان مستقیم بر شدت درد زنان مبتلا به کمردرد مزمن

نوع مقاله : مقاله پژوهشی

نویسندگان

1 کمیته پژوهشی دانشجویان، کارشناس ارشد فیزیوتراپی، دانشکده علوم توانبخشی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران

2 دانشیار گروه فیزیوتراپی، دانشکده علوم توانبخشی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران

3 پزشک عمومی، دانشگاه علوم پزشکی سمنان، سمنان، ایران

چکیده

مقدمه و اهداف
هدف مطالعه حاضر بررسی اثر a-tDCS بر شدت درد زنان مبتلا به درد مزمن کمر می­باشد.
مواد و روش‌ها
10 زن مبتلا به کمردرد مزمن در مطالعه حاضر دو سو کور، شم کنترل با طراحی متقاطع (cross over) شرکت کردند. هر یک از شرکت­کنندگان یک جلسه جریان a-tDCS با شدت ‌جریان 3/0 میلی‌آمپر، مدت‌زمان بیست دقیقه و دانسیته جریان MA/CM2 1/0 که بر منطقه M1 و DLPFC به‌طور هم‌زمان اعمال می‌شد، دریافت کردند. شدت درد و آستانه درد بیماران قبل و بعد از درمان و سطح ناتوانی افراد قبل از درمان و یک هفته پس از درمان ارزیابی ‌شد. از آزمون­های شاپیروویلک جهت بررسی توزیع داده­ها و از آزمون تی زوجی برای تحلیل داده‌ها استفاده گردید و مقدار خطای آزمون کمتر از 05/0 در نظر گرفته شد.
یافته‌ها
نتایج حاکی از عدم تاثیر درمان شم و اکتیو بر شدت درد، ناتوانی و آستانه درد این بیماران بودند. میزان تغییرات میانگین‌ها قبل و بعد درمان اکتیو برای شدت درد 9/ 0(72/0p=)، برای میزان ناتوانی 6/5 )07/0p=) و برای آستانه درد 16/0– (1/0P=) است. این مقادیر در درمان شم به ترتیب 4/0، 4/2 و 73/0–با مقدار p بزرگ‌تر از 05/0 است.
نتیجه‌گیری
این روش درمان اثری بر شدت درد زنان مبتلا به کمردرد مزمن نداشت، اگرچه این نتایج ممکن است مربوط به تعداد کم جلسات درمانی باشد.

کلیدواژه‌ها

موضوعات


عنوان مقاله [English]

Effects of One Session of a-tDCS on Women with Chronic Low Back Pain

نویسندگان [English]

  • Nahid Divandari 1
  • Farideh Dehghan Manshadi 2
  • Mehdi Vakili 3
1 Student Research Commiittee. MSc Student of Physiotherapy, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Ph.D, Associate professor in Physiotherapy , Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 General Practitioner, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran.
چکیده [English]

Background and Aims: The present study aimed to investigate the effects of a-tDCS on pain score in women with Chronic Low Back Pain (CLBP).
Materials and Methods: A total of 10 women with CLBP participated in the current double-blind sham-controlled cross-over study. Each participant received one session of a 20-minute, 0.3 mA tDCS with a current density of 0.1mA/cm2 on M1 and DLPFC, concurrently. Pain intensity and electrical pain threshold were assessed immediately prior to and after the treatment. In addition, the disability was assessed before and one week after the treatment. Shapiro-Wilks goodness-of-fit test was used for normality and dependent t-Test was used for data analysis. Values of p ≤ 0.05 were considered as statistically significant.
Results: The results showed no effect of active or sham treatment on the pain intensity, disability, and pain threshold (p>0.05). The mean difference between before and after active treatment were 0.9 (p=0.7) for pain, 5.6 (p=0.7) for disability, and-0/16 for pain threshold (p=0.1). These values were 0.4, 2.4, and -0.73 for sham treatment with p-value greater than 0.05.
Conclusion: The method studied proved to have no significant effect on pain intensity of women suffering from CLBP; however, this finding may be related to the limited sessions of the treatment.

کلیدواژه‌ها [English]

  • Chronic Low Back Pain
  • Transcranial direct current stimulation
  • Disability and pain threshold
  1. Rozenberg S. [Chronic low back pain: definition and treatment]. La Revue du praticien. 2008; 58(3):265-72. ##
  2. Chou R. Low back pain (chronic). BMJ clinical evidence. 2010; 2010.##
  3. Wand BM, Parkitny L, O'Connell NE, Luomajoki H, McAuley JH, Thacker M, et al. Cortical changes in chronic low back pain: current state of the art and implications for clinical practice. Manual therapy. 2011; 16(1):15-20. ##
  1. Luedtke K, Rushton A, Wright C, Jurgens T, Polzer A Mueller G, et al. Effectiveness of transcranial direct current stimulation preceding cognitive behavioural management for chronic low back pain: sham controlled double blinded randomised controlled trial. Bmj. 2015; 350: h1640. ##
    Hazime F, Baptista A, Freitas D, Monteiro R, Maretto R, Hasue R, et al. Treating low back pain with combined cerebral and peripheral electrical stimulation: A randomized, double‐blind, factorial clinical trial. European Journal of Pain. 2017. ##
    Schabrun SM, Jones E, Elgueta Cancino EL, Hodges PW. Targeting chronic recurrent low back pain from the top-down and the bottom-up: a combined transcranial direct current stimulation and peripheral electrical stimulation intervention. Brain Stimul. 2014; 7(3):451-9. ##
    Flor H, Braun C, Elbert T, Birbaumer N. Extensive reorganization of primary somatosensory cortex in chronic back pain patients. Neuroscience letters. 1997; 224(1):5-8. ##
    Apkarian AV, Sosa Y, Sonty S, Levy RM, Harden RN, Parrish TB, et al. Chronic back pain is associated with decreased prefrontal and thalamic gray matter density. The Journal of neuroscience: the official journal of the Society for Neuroscience. 2004; 24(46):10410-5. ##
    Giesecke T, Gracely RH, Grant MA, Nachemson A, Petzke F, Williams DA, et al. Evidence of augmented central pain processing in idiopathic chronic low back pain. Arthritis & Rheumatology. 2004; 50(2):613-23. ##

10. Schmidt-Wilcke T, Leinisch E, Gänssbauer S, Draganski B, Bogdahn U, Altmeppen J, et al. Affective components and intensity of pain correlate with structural differences in graymatter in chronic back pain patients. Pain. 2006; 125(1):89-97. ##

11. Tsao H, Galea M, Hodges P. Reorganization of the motor cortex is associated with postural control deficits in recurrent low back pain. Brain. 2008; 131(8):2161-71. ##

12. Jacobs JV, Henry SM, Nagle KJ. Low back pain associates with altered activity of the cerebral cortex prior to arm movements that require postural adjustment. Clinical Neurophysiology. 2010; 121(3):431-40. ##

13. Tsao H, Danneels LA, Hodges PW. ISSLS prize winner: Smudging the motor brain in young adults with recurrent low back pain. Spine (Phila Pa 1976). 2011; 36(21):1721-7. ##

14. Giordano J, Bikson M, Kappenman ES, Clark VP, Coslett HB, Hamblin MR, et al. Mechanisms and effects of transcranial direct current stimulation. Dose-Response. 2017; 15(1):1559325816685467. ##

15. Sankarasubramanian V, Cunningham DA, Potter-Baker KA, Beall EB, Roelle SM, Varnerin NM, et al. Transcranial Direct Current Stimulation Targeting Primary Motor Versus Dorsolateral Prefrontal Cortices: Proof-of-Concept Study Investigating Functional Connectivity of Thalamocortical Networks Specific to Sensory-Affective Information Processing. Brain Connectivity. 2017; 7(3):182-96. ##

16. Moseley GL, Flor H. Targeting cortical representations in the treatment of chronic pain: a review. Neurorehabilitation and neural repair. 2012; 26(6):646-52. ##

17. Lefaucheur J-P, Antal A, Ayache SS, Benninger DH, Brunelin J, Cogiamanian F, et al. Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS). Clinical Neurophysiology. 2017; 128(1):56-92. ##

18. Fregni F, Boggio PS, Lima MC, Ferreira MJ, Wagner T, Rigonatti SP, et al. A sham-controlled, phase II trial of transcranial direct current stimulation for the treatment of central pain in traumatic spinal cord injury. Pain. 2006; 122(1):197-209. ##

19. Cecilio SB, Zaghi S, Cecilio LB, Correa CF, Fregni F. Exploring a novel therapeutic approach with noninvasive cortical stimulation for vulvodynia. American journal of obstetrics and gynecology. 2008; 199(6):e6-e7. ##

20. Fenton BW, Palmieri, Patrick A, Boggio, Paolo, Fanning, James, Fregni, Felipe. A preliminary study of transcranial direct current stimulation for the treatment of refractory chronic pelvic pain. Brain stimulation. 2009; 2(2):103-7. ##

21. Rostami R, Bashar W. Badran ,Kazemi R, Habibnezhad M, and Mark S. George. Long-lasting analgesic effect of transcranial direct current stimulation in treatment of chronic endometriosis pain. J Obstet Gynaecol Res, No 12: 2015; 41. ##

22. O’Connell NE, Cossar J, Marston L, Wand BM, Bunce D, De Souza LH, et al. Transcranial direct current stimulation of the motor cortex in the treatment of chronic nonspecific low back pain: a randomized, double-blind exploratory study. The Clinical journal of pain. 2013; 29(1):26-34. ##

23. Luedtke K, Rushton A, Wright C, Geiss B, Juergens TP, May A. Transcranial direct current stimulation for the reduction of clinical and experimentally induced pain: a systematic review and meta-analysis. The Clinical journal of pain. 2012; 28(5):452-61. ##

24. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, et al.(2006) Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 15 Suppl 2: S192–300##

25. Vaseghi BZ, Maryam Jaberzadeh, Shapour. The effects of anodal-tDCS on corticospinal excitability enhancement and its after-effects: conventional vs. unihemispheric concurrent dual-site stimulation. Frontiers in Human Neuroscience. 2015, b; 9:533. ##

26. Mousavi sj, et al. The Oswestry Disability Index, the Roland-Morris Disability Questionnaire, and the Quebec Back Pain Disability Scale: Translation and Validation Studies of the Iranian Versions. Spine. 2006;31(4):454-9. ##

27. Baradaran A, et al. Cross-Cultural Adaptation, Validation, and Reliability Testing of the Modified Oswestry Disability Questionnaire in Persian Population with Low Back Pain. Asian Spine J 2016; 10(2):215-9. ##

28. Brunoni AR FR, Bortolomasi M, et al. Transcranial direct current stimulation (tDCS) in unipolar vs. bipolar depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:96–101. ##

29. Vaseghi B, Zoghi M, Jaberzadeh S. How does anodal transcranial direct current stimulation of the pain neuromatrix affect brain excitability and pain perception? A randomised, double-blind, sham-control study. PloS one. 2015, a; 10(3):e0118340. ##

30. Trans Cranial Technologies ldt. 2410 Fortis Tower.77-79 Gloucester Road.Wanchai.Hong Kong,2012##

31. O’Connell NE WB, Marston L, et al. Non-invasive brain stimulation techniques for chronic pain. Cochrane Database Syst Rev. 2010; CD008208. ##

32. Antal A, Terney D, Kühnl S, Paulus W. Anodal transcranial direct current stimulation of the motor cortex ameliorates chronic pain and reduces short intracortical inhibition. Journal of pain and symptom management. 2010; 39(5):890-903. ##

33. Vaseghi B, Zoghi M, Jaberzadeh S. Does anodal transcranial direct current stimulation modulate sensory perception and pain? A meta-analysis study. Clinical Neurophysiology. 2014; 125(9):1847-58. ##