| Summary: | 碩士 === 國立陽明大學 === 物理治療暨輔助科技學系 === 107 === Background: Neuropathic pain (NP) is troubling more than 50% of patients with spinal cord injury (SCI). There are some limitations of current treatments for chronic neuropathic pain. Transcranial direct current stimulation (tDCS) can provide moderate effects on SCI-related NP with a low current stimulation through anodal mode over motor cortex. However, it is lack of evidence of long-term effects on pain relief, and the use of multimodal treatment strategy is suggested. Exercises are important to individuals with spinal cord injury, and are proved to have the potential to improve NP after SCI. The modulations of activity at spinal and supraspinal level were suggested as the possible mechanisms of tDCS and exercises.
Purpose: The purpose of this study was to determine the effects of tDCS followed by exercises on neuropathic pain in individuals with chronic SCI.
Methods: This study was a double-blinded, randomized controlled trial with pre-, post-test, and 4-week follow-up measurements. Twelve patients with moderate neuropathic pain were enrolled and randomly allocated into the experimental (real tDCS and exercises, N=6) or control group (sham tDCS and exercises, N=6). The treatment protocol consisted of 12 sessions of 20-minute anodal real (or sham) tDCS and 50-minute upper body exercises accordingly. The outcomes measures included pain intensity, characters of NP, self-rating change of pain, brain activity, and quality of life. All assessments were administered at pre-test, post-test, and 4-week follow-up, except for self-rating change of pain measured at post-test and follow-up. Mann-Whitney U test was used to compare the changes of outcomes between groups, and Wilcoxon signed rank test for within group comparisons. Change values were calculated by subtracting the baseline data from the post-training or the follow-up data. Statistically significant level was set at 0.05.
Results: Participants in the experimental group demonstrated significant decrease in pain intensity (p = 0.046) and overall neuropathic pain (p = 0.046) after training, and demonstrated significantly better improvements in pain intensity (p = 0.035) and pressure evoked pain (p = 0.022) than the control group. However, there were no statistically significant changes in brain activity or improvements in quality of life.
Discussion and Conclusion: Multiple sessions of anodal tDCS with exercises may provide analgesic effects on neuropathic pain in patients with chronic spinal cord injury. However, the parallel alterations in brain activity in regions associated with neuropathic pain were not demonstrated in present study.
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