目的 探讨重复经颅磁刺激(rTMS)对脊髓损伤后慢性神经病理性疼痛的疗效。方法 2014年6月至2015年12月,8例脊髓损伤后慢性神经病理性疼痛患者应用rTMS治疗5周,治疗前后采用疼痛数字分级量表和睡眠状况自评表进行评定。结果 治疗后,患者疼痛数字分级评分下降4~6分,疼痛程度由重度降至轻中度; 睡眠状况自评分下降9~20分。结论 rTMS对部分脊髓损伤后慢性神经病理性疼痛有效,可与药物联合治疗。
ObjectiveTo observe the effect of repetitive transcranial magnetic stimunation (rTMS) on neuropathic pain after spinal cord injury. MethodsFrom June, 2014 to December, 2015, eight spinal cord injury patiens with neuropathic pain were treated with rTMS for five weeks. They were assessed with Numerical Rating Scale of pain and Self-Rating Scale of Sleep before and after treatment. ResultsAfter treatment, the score of Numerical Rating Scale decreased 4 to 6 points, namely from severe pain to mild to moderate pain. The score of Self-Rating Scale of Sleep decreased 9 to 20 points. ConclusionrTMS may relieve neuropathic pain after spinal cord injury, and can be combined with medcine.
[1] 王茂斌, O'Young BJ, Ward CD. 神经康复学[M]. 北京:人民卫生出版社, 2009.
[2] Jensen TS, Baron R, Haapaa M, et al. A new definition of neuropathic pain [J]. Pain, 2011, 152(10): 2204-2205.
[3] 高飞,冯艺. 不同靶点重复经颅磁刺激在治疗神经病理性疼痛中的应用[J]. 中国疼痛医学杂志, 2015, 21(12): 881-884.
[4] 陈富勇,陶蔚,孙伟,等. 重复经颅磁刺激治疗慢性神经病理性疼痛[J]. 中国微侵袭神经外科杂志, 2013, 18(2): 57-59.
[5] Lefaucheur JP, Drouot X, Menard-Lefaucheur I, et al. Motor cortex rTMS in chronic neuropathic pain: pain relief is associated with thermal sensory perception improvement [J]. Neurol Neurosurg Psychiatry, 2008, 79(9): 1044-1049.
[6] Saitoh Y, Maruo T, Yokoe M, et al. Electrical or repetitive transcranial magnetic stimulation of primary motor cortex for intractable neuropathic pain [J]. Conf Proc IEEE Eng Med Biol Soc, 2013, 170(7): 6163-6166.
[7] Khedr EM, Kotb H, Kamel NF, et al. Long lasting antalgic effects of daily sessions of repetitive transcranial magnetic stimulation in central and peripheral neuropathic pain [J]. J Neurol Neurosurg Psychiatry, 2005, 76(6): 833-838.
[8] Cruz-Almeida Y, Martinez-Arizala A, Widerstrom-Noga EG. Chronicity of pain associated with spinal cord injury: A longitudinal analysis [J]. J Rehabil Res Dev, 2005, 42(5): 585-594.
[9] Bryce TN, Biering-Sorensen F, Finnerup NB, et al. International spinal cord injury pain classification: Part I. Background and description. March 6-7, 2009 [J]. Spinal Cord, 2012, 50(6): 413-417.
[10] Bouhassira D, Lantéri-Minet M, Attal N, et al. Prevalance of chornic pain with neuropathic characteristics in the general population [J]. Pain, 2008, 136(3): 380-387.
[11] Li CL. Spinal dorsal horn calcium channel α 2-δ1 subunit upregulation contributes to peripheral nerve injury-induced tactile allodynia [J]. J Neurosci, 2004, 24(39): 8494-8499.
[12] Dooley DJ. Ca 2+ channel α 2-δ ligands: novel modulators of neurotransmission [J]. Trend Pharm Sci, 2006, 28(2): 75-82.
[13] 高崇荣,樊碧发,卢振和. 神经病理性疼痛学[M]. 北京:人民卫生出版社, 2013.
[14] 神经病理性疼痛诊疗专家组. 神经病理性疼痛诊疗专家共识[J]. 中国疼痛医学杂志, 2013, 19(12): 705-710.
[15] Lefaucheur JP, Hatem S, Nineb A, et al. Somatotopic organ ization of the analgesic effects of motor cortex rTMS in neuropathic pain [J]. Neurology, 2006, 67(11): 1998-2004.
[16] Fregni F, Potvin K, Dasilva D, et al. Clinnical effects and brain metabolic correlates in noninvasive cortical neuromodulation for visceral pain [J]. Eur J Pain, 2011, 15(1): 53-60.
[17] Silva G, Miksad R, Freedman SD, et al. Treatment of cancer pain with noninvasive brain stimulation [J]. Pain Symptom Manage, 2007, 34(4): 342-345.
[18] Misra UK, Kalita J, Bhoi SK. High frequency repetitive transcranial magnetic stimulation (rTMS) is effective in migraine prophylaxis: an open labeled study [J]. Neurol Res, 2012, 34(6): 547-551.
[19] Brighina F, De Tommaso M, Giglia F, et al. Modulation of pain perception by transcranial magnetic stimulation of left prefrontal cortex [J]. J Headache Pain, 2011, 12(2): 185-191.
[20] Fregni F, Gimenes R, Valle AC, et al. A randomized sham controlled, proof of principle study of transcranial direct current stimulation for the treatment of pain in fibromyalgia [J]. Arthritis Rheum, 2006, 54(12): 3988-3998.
[21] Pleger B, janssen F, Schwenkreis P, et al. Repetitive transcranial magnetic stimulation of the motor cortex attenuates pain perception in complex regional pain syndrome type I [J]. Neurosci Lett, 2004, 356(2): 87-90.
[22] Kang BS, Shin HI, Bang MS. Effect of repetitive transcranial magnetic stimulation over the hang motor cortical area on central pain after spinal cord injury [J]. Arch Phts Med Rehabil, 2009, 90(10): 1766-1771.
[23] Lefaucheur JP, Drounot X, Menard- Lefaucheur I, et al. Motor cortex rTMS restores defective intracortical inhibition in chronic neuropathic pain [J]. Neurology, 2006, 67(9): 1568-1574.
[24] Andre-Obadia N, Peyron R, Meriens P, et al. Transcranial magnetic stimulation for pain control double-blind study of different frequencies against placebo, and correlation with motor cortex stimulation efficacy [J]. Clin Neurophysiol, 2006, 117(7): 1536-1544.
[25] Canavero S, Bonicalzi V, Dotta M, et al. Transcranial magnetic cortical stimulation relieves central pain [J]. Stereotact Funct Neurosurg, 2002, 78(3-4): 192-196.
[26] Gustin SM, Wrigley PJ, Youssef AM, et al. Thalamic activity and biochemical change in individuals with neuropathic pain after spinal cord injury [J]. Pain, 2014, 155(5): 1027-1036.