不同强度电针对膝骨关节炎患者慢性疼痛的影响

Effect of different electroacupuncture intensities on chronic pain in patients with knee osteoarthritis

目的观察不同强度电针(electroacupuncture,EA)对膝骨关节炎(knee osteoarthritis,KOA)患者慢性疼痛的影响。方法选取313例KOA患者,随机分为强EA组(154例)、弱EA组(80例)和假EA组(79例)。强EA组采用强EA干预,电流强度为2~5 mA;弱EA组采用弱EA干预,电流强度为0~0.5 mA;假EA组采用非穴位EA干预。观察3组治疗前后疼痛视觉模拟量表(visual analog scale,VAS)评分、条件性疼痛调节(conditioned pain modulation,CPM)值、西安大略和麦克马斯特大学骨关节炎指数(Western Ontario and McMaster Universities arthritis index,WOMAC)、数字疼痛评分量表(numerical pain rating scale,NPRS)、情绪量表(emotion rating scale,ES)和当前疼痛强度(present pain intensity,PPI)评分变化。结果强EA组治疗1周后和治疗后的CPM高于治疗前(P<0.05),强EA组治疗1周后和治疗后VAS、WOMAC、NPRS、ES和PPI评分低于治疗前(P<0.05),弱EA组治疗后VAS和NPRS评分低于治疗前(P<0.05)。3组治疗1周后和治疗后CPM比较,差异有统计学意义(P<0.05),强EA组高于弱EA组和假EA组(P<0.05),弱EA组高于假EA组(P<0.05)。3组治疗后VAS评分比较,差异有统计学意义(P<0.05),强EA组低于弱EA组和假EA组(P<0.05),弱EA组低于假EA组(P<0.05)。3组治疗1周后和治疗后WOMAC、NPRS、ES和PPI评分比较,差异有统计学意义(P<0.05);治疗1周后,强EA组WOMAC、NPRS、ES和PPI评分低于假EA组(P<0.05),弱EA组NPRS评分低于假EA组(P<0.05);治疗后,强EA组WOMAC、NPRS和ES评分低于弱EA组和假EA组(P<0.05)且弱EA组低于假EA组(P<0.05),强EA组和弱EA组PPI评分低于假EA组(P<0.05)。结论EA能改善KOA患者的疼痛及关节功能,强EA在减轻疼痛强度和抑制慢性疼痛方面优于弱EA或假EA。

Objective To observe the effect of different electroacupuncture(EA)intensities on chronic pain in patients with osteoarthritis of the knee.Method A total of 313 patients with knee osteoarthritis(KOA)were selected and randomly divided into strong EA group(154 patients),weak EA group(80 patients)and sham EA group(79 patients).The strong EA group used strong EA intervention with a current intensity of 2-5 mA;the weak EA group used weak EA intervention with a current intensity of 0-0.5 mA;and the sham EA group used non-acupuncture intervention.The visual analog scale(VAS)scores,conditioned pain modulation(CPM)values,Western Ontario and McMaster Universities arthritis index(WOMAC),the numerical pain rating scale(NPRS),the emotion rating scale(ES),and the present pain intensity(PPI)scores of the three groups were observed before and after treatment.Result After 1 week treatment and after treatment,CPM in the strong EA group was higher than that before treatment(P<0.05),and VAS,WOMAC,NPRS,ES and PPI scores in the strong EA group were lower than those before treatment(P<0.05),and VAS and NPRS scores in the weak EA group were lower than those before treatment(P<0.05).There was a significant difference in CPM between the three groups after 1 week treatment and after treatment(P<0.05).CPM in the strong EA group was higher than that in the weak EA group and the sham EA group(P<0.05),and CPM in the weak EA group was higher than that in the sham EA group(P<0.05).There was a significant difference in VAS score between the three groups after treatment(P<0.05),the strong EA group was lower than the weak EA group and the sham EA group(P<0.05),and the weak EA group was lower than the sham EA group(P<0.05).There were significant differences in WOMAC,NPRS,ES and PPI scores among the three groups after1 week treatment and after treatment(P<0.05).After 1 week treatment,the WOMAC,NPRS,ES and PPI scores in the strong EA group were lower than those in the sham EA group(P<0.05),and the NPRS score in the weak EA group was lower than that in the sham EA group(P<0.05).After treatment,the WOMAC,NPRS and ES scores in the strong EA group were lower than those in the weak EA group and the sham EA group(P<0.05),the weak EA group was lower than the sham EA group(P<0.05),and the PPI scores in the strong EA group and the weak EA group were lower than the sham EA group(P<0.05).Conclusion EA can improve pain and joint function in patients with KOA,and strong EA is superior to weak EA or sham EA in reducing pain intensity and inhibiting chronic pain.