针刺对无先兆偏头痛患者机械痛阈值的影响

Effect of Acupuncture on Mechanical Pain Thresholds in Patients with Migraine Without Aura

目的:观察无先兆偏头痛患者(Migraine Without Aura, MWoA)印堂、太阳、大椎、百会、风池、颊车是否存在痛敏现象,并对比经穴针刺与安慰针刺对此穴位的机械痛阈值的影响,探讨针刺对无先兆偏头痛患者痛敏的改善,并为临床治疗提供更科学的依据。方法:将50例MWoA患者随机分为经穴针刺组与安慰针刺组,并纳入25例健康受试者作为对照。研究周期共20周,其中基线期4周,治疗期4周,随访期12周。治疗期间,隔日治疗1次,每周治疗3次,连续治疗12次。主要结局指标为入组0周、4周及随访12周时患者印堂、太阳、大椎、百会、风池、颊车的机械痛阈值;次要结局指标为头痛发作次数、头痛程度、头痛持续时间。结果:MWoA患者百会、大椎、风池机械痛阈值较健康人低,差异具有统计学意义(P<0.05)。治疗4周、随访12周时,经穴针刺组患者风池、大椎机械痛阈值升高,差异具有统计学意义(P<0.05);安慰针刺组在治疗4周后、随访12周时均无明显差异(P>0.05)。经穴针刺组治疗4周、随访12周时头痛发作次数、头痛持续时间、VAS评分均下降,具有统计学意义(P<0.05)。安慰针刺组VAS得分在治疗4周、随访12周时下降;头痛发作次数、头痛持续时间在随访12周时具有差异(P<0.05)。结论:MWoA患者存在一定程度的痛觉敏化,针刺可能通过提高MWoA患者风池、大椎的机械痛域,在一定程度上减轻了患者的疼痛敏感度,改善患者头痛发作情况;且相较安慰针刺具有显著优势,对降低MWoA患者痛觉过敏有一定意义。

Objective:To observe whether there is pain sensitivity in Migraine Without Aura(MWoA)patients with Yintang(EX-HN3),Taiyang(EX-HN5),Dazhui(DU14),Baihui(DU20),Fengchi(GB20)and Jiache(ST6),and to compare the effect of acupuncture via acupuncture points with that of comfort acupuncture points on the mechanical pain threshold of these acupuncture points,to explore the improvement of pain sensitivity in Migraine Without Aura patients by acupuncture and to provide a more scientific basis for clinical treatment.Methods:50 patients with MWoA were randomly divided into a meridian acupuncture group and a comfort acupuncture group,and 25 healthy subjects were included as controls.The study period was 20 weeks in total,including a baseline period of 4 weeks,a treatment period of 4 weeks,and a follow-up period of 12 weeks.During the treatment period,treatment was given once every other day,three times a week,and 12 consecutive treatments.The primary outcome indicators were the mechanical pain thresholds of Yintang(EX-HN3),Taiyang(EX-HN5),Dazhui(DU14),Baihui(DU20),Fengchi(GB20),and Jiache(ST6)in patients at 0 and 4 weeks of enrollment and 12 weeks of follow-up;the secondary outcome indicators were the number of headache attacks,the degree of headache,and the duration of headache.Results:The mechanical pain thresholds of Baihui(DU20),Dazhi(DU14),and Fengchi(GB20)were lower in MWoA patients than in healthy subjects,and the difference was statistically significant(P<0.05).At 4 weeks of treatment and 12 weeks of follow-up,the mechanical pain thresholds of Fengchi(GB20)and Dazhui(DU14)were higher in the patients in the meridian acupuncture group,and the difference was statistically significant(P<0.05);there was no significant difference in the comfort acupuncture group after 4 weeks of treatment and at 12 weeks of follow-up(P>0.05).The number of headache attacks,headache duration,and VAS scores decreased in the meridian acupuncture group at 4 weeks of treatment and 12 weeks of follow-up,which was statistically significant(P<0.05).VAS scores decreased in the comfort acupuncture group at 4 weeks of treatment and 12 weeks of follow-up;the number of headache attacks and headache duration were different at 12 weeks of follow-up(P<0.05).Conclusion:A certain degree of nociceptive sensitization exists in patients with MWoA,and acupuncture may have reduced pain sensitivity and improved headache attacks in patients with MWoA to some extent by increasing the mechanical pain domain of Fengchi(GB20)and Dazhui(DU14)in patients with MWoA;and it has a significant advantage over comfort acupuncture,which is meaningful in reducing nociceptive sensitization in patients with MWoA.