併存するうつ病と慢性疼痛に対する多標的経頭蓋直流刺激:多施設共同ランダム化比較試験
併存するうつ病と疼痛に対する経頭蓋電気刺激法:技術開発から多施設共同試験における臨床応用まで
調査の概要
状態
状態
条件
条件
介入・治療
介入・治療
研究の種類
研究の種類
入学 (推定)
入学
段階
段階
- 適用できない
連絡先と場所
研究連絡先
研究連絡先
- 名前:jianhua Chen
- 電話番号:(+86) 18017311011
- メール:jianhua.chen@smhc.org.cn
研究場所
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Shanghai Municipality
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Shanghai、Shanghai Municipality、中国、200072
- 募集
- Shanghai Tenth People's Hospital
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コンタクト:
- enzhao Cong
- 電話番号:congenzhao@163.com
- メール:congenzhao@163.com
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Shanghai、Shanghai Municipality、中国、200030
- 募集
- Shanghai Mental Health Center
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コンタクト:
- jianhua Chen
- 電話番号:(+86) 18017311011
- メール:jianhua.chen@smhc.org.cn
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コンタクト:
- haoyun Tang
- 電話番号:(+86) 18117197217
- メール:tanghy0809@163.com
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参加基準
適格基準
適格基準
就学可能な年齢
- 大人
- 高齢者
健康ボランティアの受け入れ
説明
対象基準:
- 年齢18~65歳;
- ICD-11に基づく抑うつエピソードの診断基準を満たし、現在軽度から中等度の抑うつ症状を有すること(HAMD-24スコア≥8かつ≤34);
- 持続性の疼痛(3カ月以上継続)を報告し、簡易疼痛評価尺度(BPI)項目5のスコアが≥4であること;
- 登録前少なくとも4週間、安定した抗うつ薬および心理的治療計画(用量、薬剤種類、治療アプローチを含む)を維持していること;
- 利き手が右、聴覚、視力または矯正視力が正常であること;
- 研究参加に自発的に書面によるインフォームド・コンセントを提供でき、すべての研究手順に従う意思と能力を有すること。
除外基準:
- 統合失調症スペクトラム障害、双極I型障害(躁病エピソードのリスクおよびリチウムまたは抗けいれん薬の禁忌のため)、原発性不安障害、重度の身体疾患に伴ううつ病など、他の精神疾患の診断を受けていること。
- 積極的な自殺念慮(HAMD-24項目3のスコアが4と定義される)。
- 重度または治療抵抗性うつ病(HAMD-24スコア≥35、現在の抑うつエピソードが少なくとも2年間持続、または現在のエピソード中に2つ以上の抗うつ治療に反応しなかった)。
- 過去3カ月以内の物質使用障害。
- がん疼痛症候群、内臓痛(例:胃痛)、または関連痛(例:膵炎による腰痛)による悪性疼痛の経験。
- 構造的脳異常に関連する神経疾患(例:外傷性脳損傷、最近の脳卒中、脳腫瘍)。
- 過去3カ月以内に神経調節治療(修正型電気けいれん療法(MECT)、反復経頭蓋磁気刺激(rTMS)、経頭蓋電気刺激(tES)を含む)を受けたこと。
- 経頭蓋電気刺激の禁忌(例:頭蓋内金属インプラント、心臓ペースメーカー、人工内耳、刺激部位の皮膚病変、個人または家族のてんかん歴)。
- 現在または過去1カ月以内に、中枢神経系の興奮性または疼痛に影響を与える薬剤(抗けいれん薬、リチウム、オピオイド、非ステロイド性抗炎症薬、抗精神病薬など)の使用。救済薬としてのアセトアミノフェンの必要時使用は許可されるが、研究日誌に詳細に記録すること。
- 認知症または他の重度の認知障害の兆候(MoCAスコア<17)。
- 重度または不安定な身体疾患(以下に限定されない):神経疾患(例:てんかん、脳卒中、片頭痛、頭蓋手術歴);心血管疾患(例:管理不良の高血圧、心不全、不整脈、心筋梗塞);呼吸器疾患(例:重度の睡眠時無呼吸症候群);悪性腫瘍または免疫不全状態;管理不良の糖尿病(空腹時血糖>12 mmol/L)。
- 妊娠中または授乳中。
- 他の臨床試験への同時参加、過去90日以内の臨床試験参加、または研究期間中の他の試験参加計画。
- 磁気共鳴画像法(MRI)の禁忌(例:金属インプラント、閉所恐怖症、呼吸または運動障害)。
- 研究評価への協力が不可能な場合。
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:処理
- 割り当て:ランダム化
- 介入モデル:並列代入
- マスキング:トリプル
アーム数
武器と介入
参加者グループ / アーム参加者グループ / アーム |
介入・治療介入・治療 |
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実験的:tDCS
Participants receive active tDCS.
The anodal electrode is placed over the left dorsolateral prefrontal cortex (F3), and the cathodal electrode is placed over the right dorsolateral prefrontal cortex (F4).
A constant current of 2 mA is applied for 40 minutes per session, with a 30-second ramp-up and ramp-down period.
The intervention is administered once daily for 2 weeks (total of 10 sessions).
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Participants receive active tDCS.
The anodal electrode (5 × 5 cm) is placed over the left dorsolateral prefrontal cortex (F3), and the cathodal electrode (5 × 7 cm) is placed over the right dorsolateral prefrontal cortex (F4).
A constant current of 2 mA is applied for 40 minutes per session, with a 30-second ramp-up and ramp-down period.
The intervention is administered once daily for 2 weeks (total of 10 sessions).
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実験的:alpha-tACS
Participants receive active alpha-tACS.
Two electrodes are placed over F3 and F4.
A sinusoidal alternating current at 10 Hz frequency (alpha band) is applied 1 mA (zero-to-peak) at the F3 and F4 electrodes.
Stimulation duration is 40 minutes per session, including 30-second ramp-up and ramp-down periods.
The intervention is administered once daily, 5 days per week, for 2 weeks (total of 10 sessions).
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Participants receive active alpha-tACS.
Two electrodes are placed over F3 and F4.
A sinusoidal alternating current at 10 Hz frequency (alpha band) is applied 1 mA (zero-to-peak) at the F3 and F4 electrodes.
Stimulation duration is 40 minutes per session, including 30-second ramp-up and ramp-down periods.
The intervention is administered once daily, 5 days per week, for 2 weeks (total of 10 sessions).
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偽コンパレータ:Sham
Sham group using the same electrode montage at F3/F4.
To maintain blinding, the stimulator delivers current only during the initial 30-second ramp-up period, followed by an immediate ramp-down, and a final 30-second ramp-up at the end of the stimulation session.
This mimics the initial sensation of active stimulation without delivering sufficient current to induce neural modulation.
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Sham group using the same electrode montage at F3/F4.
To maintain blinding, the stimulator delivers current only during the initial 30-second ramp-up period, followed by an immediate ramp-down, and a final 30-second ramp-up at the end of the stimulation session.
This mimics the initial sensation of active stimulation without delivering sufficient current to induce neural modulation.
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実験的:Exploratory Open-Label tACS Group
Participants in this exploratory arm receive the same active tACS intervention as Arm alpha-tACS, with identical stimulation parameters (e.g., 1 mA, 40 minutes, 10 Hz, targeting the bilateral dorsolateral prefrontal cortex (DLPFC)).
This arm is open-label (unblinded): participants and study personnel are aware of the treatment assignment.
It serves as a supplementary exploratory cohort to explore preliminary neural oscillation entrainment effects of tACS.
Unlike Arms 1-3, this arm is neither randomized nor blinded.
Data from this arm will be analyzed separately and are not included in the primary confirmatory hypothesis testing of the randomized controlled trial.
The overall study remains double-blind for the three-arm RCT component, with this exploratory arm conducted as an ancillary cohort.
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Participants receive active alpha-tACS.
Two electrodes are placed over F3 and F4.
A sinusoidal alternating current at 10 Hz frequency (alpha band) is applied 1 mA (zero-to-peak) at the F3 and F4 electrodes.
Stimulation duration is 40 minutes per session, including 30-second ramp-up and ramp-down periods.
The intervention is administered once daily, 5 days per week, for 2 weeks (total of 10 sessions).
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この研究は何を測定していますか?
主要な結果の測定
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Proportion of Participants Achieving MCID on BPI Pain Intensity Subscale
時間枠:At 1 week (mid-intervention), 2 weeks (end of intervention), and 6 weeks (follow-up) post-baseline
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Description: The BPI is a validated self-administered questionnaire that assesses the severity of pain and its impact on daily functioning. The pain intensity subscale consists of four items rating pain at its "worst," "least," "average," and "current" (right now). Each item is rated on a 0 to 10 numeric rating scale. Higher scores mean a worse outcome. The Minimal Clinically Important Difference (MCID) is defined as a reduction of ≥ 1 point from baseline in the BPI pain intensity score. The outcome is the proportion of participants in each group who achieve this MCID threshold at each follow-up time point. |
At 1 week (mid-intervention), 2 weeks (end of intervention), and 6 weeks (follow-up) post-baseline
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二次結果の測定
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Percentage Reduction from Baseline in HAMD-17 Total Score
時間枠:At 1 week (mid-intervention), 2 weeks (end of intervention), and 6 weeks (follow-up) post-baseline
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The HAMD-17 is a 17-item clinician-rated scale assessing depression severity. Items are rated on 3- or 5-point scales, with total scores ranging from 0 to 52. Higher scores mean a worse outcome (greater depression severity). The outcome is the percentage reduction in HAMD-17 total score from baseline at each follow-up time point, calculated using the formula: [(Baseline score - Follow-up score) / Baseline score] × 100% A positive percentage indicates improvement (reduction in depressive symptoms). |
At 1 week (mid-intervention), 2 weeks (end of intervention), and 6 weeks (follow-up) post-baseline
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Change from Baseline in HAMD-17 Total Score
時間枠:At 1 week (mid-intervention), 2 weeks (post-intervention), and 6 weeks (follow-up)
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The Hamilton Depression Rating Scale (HAMD-17) is a 17-item clinician-rated scale assessing depression severity.
Items are rated on 3- or 5-point scales, with total scores ranging from 0 to 52.
Higher scores indicate greater depression severity (worse outcome).
The outcome is the absolute change in the total score from baseline at each follow-up time point, calculated as: [(Baseline score) - (Follow-up score)].
A positive change value indicates improvement (reduction in depressive symptoms).
No pre-defined clinically meaningful threshold is applied to this continuous outcome; it is reported as the mean absolute change per group.
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At 1 week (mid-intervention), 2 weeks (post-intervention), and 6 weeks (follow-up)
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Change from Baseline in Pain Catastrophizing Scale (PCS) Total Score
時間枠:At 1 week (mid-intervention), 2 weeks (end of intervention), and 6 weeks (follow-up) post-baseline
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The Pain Catastrophizing Scale (PCS) is a 13-item self-reported questionnaire.
Each item is rated on a 5-point Likert scale from 0 (not at all) to 4 (all the time), with total scores ranging from 0 to 52.
Higher scores indicate higher levels of pain catastrophizing (worse outcome).
The outcome is the absolute change in the total score from baseline at each follow-up time point, calculated as: [(Baseline score) - (Follow-up score)].
A positive change value indicates improvement (reduction in pain catastrophizing).
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At 1 week (mid-intervention), 2 weeks (end of intervention), and 6 weeks (follow-up) post-baseline
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Change from Baseline in Generalized Anxiety Disorder Scale-7 (GAD-7) Total Score
時間枠:At 1 week (mid-intervention), 2 weeks (end of intervention), and 6 weeks (follow-up) post-baseline
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The GAD-7 is a 7-item self-report scale (0-21, higher scores = worse outcome) assessing anxiety symptoms over the past two weeks.
The outcome is the absolute change in the total score from baseline at each follow-up time point, calculated as: [(Baseline score) - (Follow-up score)].
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At 1 week (mid-intervention), 2 weeks (end of intervention), and 6 weeks (follow-up) post-baseline
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Change from Baseline in Clinical Global Impression (CGI) Total Score
時間枠:At 1 week (mid-intervention), 2 weeks (post-intervention), and 6 weeks (follow-up)
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The Clinical Global Impression (CGI) scale consists of two clinician-rated subscales assessing overall treatment response: CGI-Severity (CGI-S): Rates the severity of the patient's illness on a 7-point scale from 1 (normal, not at all ill) to 7 (among the most extremely ill patients). Higher scores mean a worse outcome. CGI-Improvement (CGI-I): Rates the patient's improvement compared to baseline on a 7-point scale from 1 (very much improved) to 7 (very much worse). This subscale is only assessed at post-baseline time points. Lower scores mean a better outcome (greater improvement). The outcome is the change from baseline in CGI-S score at each follow-up time point, and the CGI-I score at each post-baseline time point. |
At 1 week (mid-intervention), 2 weeks (post-intervention), and 6 weeks (follow-up)
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Change from Baseline in Resting-State Functional Connectivity of the DLPFC at 2 Weeks
時間枠:Baseline and immediately after the 2-week intervention period
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Resting-state functional connectivity (rs-FC) of the dorsolateral prefrontal cortex (DLPFC) is assessed using resting-state functional magnetic resonance imaging (rs-fMRI).
The primary measurement is the change in seed-based functional connectivity strength between the DLPFC and its target network regions (e.g., parietal cortex, default mode network nodes), quantified as Fisher-transformed correlation coefficients (z-values) from a priori defined regions of interest.
Higher z-values indicate stronger positive functional connectivity; lower or negative values indicate weaker or anticorrelated connectivity.
Structural MRI (sMRI) is acquired for co-registration and normalization purposes.
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Baseline and immediately after the 2-week intervention period
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その他の成果指標
その他の成果指標
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Change from Baseline in Brain-Derived Exosome Metabolite Levels
時間枠:From baseline to post-intervention at 2 weeks
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Metabolite profiles are measured using untargeted liquid chromatography-mass spectrometry (LC-MS) in plasma-derived brain-enriched exosomes.
Changes in metabolite profiles from baseline to post-intervention are assessed using multivariate partial least squares discriminant analysis (PLS-DA).
The primary comparison is the separation distance (e.g., Q² or R² values) between baseline and post-intervention clusters, with positive values indicating greater separation between the two time points.
This is an exploratory outcome to identify potential metabolic biomarkers and generate hypotheses related to the mechanisms of tACS/tDCS action.
Results will be reported descriptively and are not part of the primary confirmatory analysis.
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From baseline to post-intervention at 2 weeks
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Change from Baseline in BPI Pain Intensity Score in the Exploratory Open-Label Cohort
時間枠:From baseline to post-intervention at 2 weeks
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This exploratory outcome measures the change from baseline in the BPI Pain Intensity score after 10 sessions of active tACS in the open-label arm.
Data are reported descriptively as individual change values, mean change, standard deviation, and within-group effect size (Cohen's d) .
No formal hypothesis testing is planned; the results will inform effect size estimation for future trial planning.
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From baseline to post-intervention at 2 weeks
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Change from Baseline in HAMD-17 Total Score in the Exploratory Open-Label Cohort
時間枠:From baseline to post-intervention at 2 weeks
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This exploratory outcome measures the change from baseline in HAMD-17 total score after 10 sessions of active tACS in the open-label arm.
Data are reported descriptively as individual change values, mean change, standard deviation, and within-group effect size (Cohen's d).
No formal hypothesis testing is planned; the results will inform effect size estimation for future trial planning.
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From baseline to post-intervention at 2 weeks
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Change from Baseline in GAD-7 Total Score in the Exploratory Open-Label Cohort
時間枠:From baseline to post-intervention at 2 weeks
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This exploratory outcome measures the change from baseline in GAD-7 total score after 10 sessions of active tACS in the open-label arm.
Data are reported descriptively as individual change values, mean change, standard deviation, and within-group effect size (Cohen's d).
No formal hypothesis testing is planned.
GAD-7 scores will also be explored as a covariate in pain outcome analyses.
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From baseline to post-intervention at 2 weeks
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Change from Baseline in Resting-State EEG Power Spectra in the Exploratory Open-Label Cohort
時間枠:Baseline, Day 1 (immediately before and after the 1st tACS session), Day 10 (immediately before and after the 10th tACS session), and Day 11 (on the day after completion of all 10 sessions)
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Resting-state EEG is recorded for 5 minutes with eyes open and 5 minutes with eyes closed using a 64-channel EEG system.
The primary measure is the change from baseline in spectral power (absolute and relative) across frequency bands (delta: 1-4 Hz, theta: 4-8 Hz, alpha: 8-12 Hz, beta: 12-30 Hz, gamma: 30-50 Hz), with a focus on the alpha band (8-12 Hz) due to the 10 Hz tACS intervention.
Data are analyzed descriptively without formal hypothesis testing.
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Baseline, Day 1 (immediately before and after the 1st tACS session), Day 10 (immediately before and after the 10th tACS session), and Day 11 (on the day after completion of all 10 sessions)
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Change from Baseline in Task-State EEG (Event-Related Potentials) in the Exploratory Open-Label Cohort
時間枠:Baseline and Day 11 (on the day after completion of all 10 tACS sessions)
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Task-state EEG is recorded while participants perform a cognitive task (e.g., working memory or attention task).
The primary measure is the change from baseline in event-related potential (ERP) components and task-related spectral power changes (event-related desynchronization/synchronization).
Data are analyzed descriptively without formal hypothesis testing.
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Baseline and Day 11 (on the day after completion of all 10 tACS sessions)
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Change from Baseline in Resting-State EEG Functional Connectivity in the Exploratory Open-Label Cohort
時間枠:Baseline and Day 11 (on the day after completion of all 10 sessions)
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Resting-state EEG functional connectivity is assessed using coherence and phase-locking value (PLV) between electrode pairs, with a focus on the alpha band and the DLPFC region.
Data are analyzed descriptively without formal hypothesis testing.
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Baseline and Day 11 (on the day after completion of all 10 sessions)
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協力者と研究者
協力者
協力者
研究記録日
主要日程の研究
研究開始 (推定)
研究開始
一次修了 (推定)
一次修了
研究の完了 (推定)
研究の完了
試験登録日
最初に提出
最初に提出
QC基準を満たした最初の提出物
QC基準を満たした最初の提出物
最初の投稿 (実際)
最初の投稿
学習記録の更新
投稿された最後の更新 (実際)
投稿された最後の更新
QC基準を満たした最後の更新が送信されました
QC基準を満たした最後の更新が送信されました
最終確認日
最終確認日
詳しくは
本研究に関する用語
追加の関連 MeSH 用語
その他の研究ID番号
その他の研究ID番号
- 2025-80
個々の参加者データ (IPD) の計画
個々の参加者データ (IPD) を共有する予定はありますか?
医薬品およびデバイス情報、研究文書
米国FDA規制医薬品の研究
米国FDA規制機器製品の研究
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