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针刺对无先兆偏头痛患者机械痛阈值的影响

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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.
Effect of Acupuncture on Mechanical Pain Thresholds in Patients with Migraine Without Aura
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 acu-puncture 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 acu-puncture 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 thresh-olds 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 de-gree 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 head-ache 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 treat-ment 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.

Migraine without auraMechanical pain sensitizationAcupuncture analgesiaMechanical pain thresholdClinical re-search

高小雨、张雨桐、谢朝荣、廖雨莎、赵凌

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成都中医药大学 针灸推拿学院, 四川 成都 611137

无先兆偏头痛 机械痛敏化 针刺镇痛 机械痛阈 临床研究

国家自然科学基金委员会面上项目

81973962

2024

成都中医药大学学报
成都中医药大学

成都中医药大学学报

影响因子:0.572
ISSN:1004-0668
年,卷(期):2024.47(1)
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