Reduction of intractable deafferentation pain by navigation-guided repetitive transcranial magnetic stimulation of the primary motor cortex
Reduction of intractable deafferentation pain by navigation-guided repetitive transcranial magnetic stimulation of the primary motor cortex
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DOI：
10.1016/j.pain.2005.12.001
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发表时间：
2006-05-01
期刊：
影响因子：
7.4
通讯作者：
Yoshimine, Toshiki
中科院分区：
文献类型：
--
作者：
Hirayama, Azuma;Saitoh, Youichi;Yoshimine, Toshiki
中央前回(M1)是电刺激治疗疼痛的典型靶点。到目前为止，很少有研究人员调查是否可以通过刺激M1以外的皮质区域来缓解疼痛。根据最近的报道，重复经颅磁刺激(RTMS)可以提供类似于电刺激的效果。考虑到这一点，我们因此使用导航引导的rTMS检查了几个皮层区域作为刺激目标，并比较了不同目标对疼痛的影响。对20例顽固性传入性疼痛患者进行了M1、中央后回(SI)、运动前区(PREM)和辅助运动区(SMA)的rTMS检查。每个靶点用10列10-S 5-HzTMS脉冲刺激，每列之间有50-S间隔。强度调整为静息运动阈值的90%。因此，总共施加了500个刺激。假刺激是随机进行的。采用视觉模拟评分(VAS)和简式麦吉尔疼痛问卷(SF-MPQ)评定rTMS对疼痛的疗效。20名患者中有10名(50%)表示，刺激M1，而不是其他区域，提供了显著和有益的疼痛缓解(p<；0.01)。结果表明，MI刺激后持续3h的作用具有统计学意义(p<；0.05)。对其他靶点的刺激没有效果。尽管M1、S1、PREM和SMA相邻，但M1是rTMS治疗顽固性疼痛的唯一靶点。(C)2005年国际疼痛研究协会。爱思唯尔出版，版权所有。
The precentral gyrus (M1) is a representative target for electrical stimulation therapy of pain. To date, few researchers have investigated whether pain relief is possible by stimulation of cortical areas other than M1. According to recent reports, repetitive transcranial magnetic stimulation (rTMS) can provide an effect similar to that of electrical stimulation. With this in mind, we therefore examined several cortical areas as stimulation targets using a navigation-guided rTMS and compared the effects of the different targets on pain. Twenty patients with intractable deafferentation pain received rTMS of M1, the postcentral gyrus (SI), premotor area (preM), and supplementary motor area (SMA). Each target was stimulated with ten trains of 10-s 5-Hz TMS pulses, with 50-s intervals in between trains. Intensities were adjusted to 90% of resting motor thresholds. Thus, a total of 500 stimuli were applied. Sham stimulations were undertaken at random. The effect of rTMS on pain was rated by patients using a visual analogue scale (VAS) and the short form of the McGill Pain Questionnaire (SF-MPQ). Ten of the 20 patients (50%) indicated that stimulation of M1, but not other areas, provided significant and beneficial pain relief (p < 0.01). Results indicated a statistically significant effect lasting for 3 hours after the stimulation of M I (p < 0.05). Stimulation of other targets was not effective. The M1 was the sole target for treating intractable pain with rTMS, in spite of the fact that M1, S1, preM, and SMA are located adjacently. (c) 2005 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.