Reducing pain and unpleasantness during repetitive transcranial magnetic stimulation
Reducing pain and unpleasantness during repetitive transcranial magnetic stimulation
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DOI：
10.1097/01.yct.0000244248.40662.9a
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发表时间：
2006-12-01
期刊：
影响因子：
2.5
通讯作者：
George, Mark S.
中科院分区：
文献类型：
--
作者：
Borckardt, Jeffrey J.;Smith, Arthur R.;George, Mark S.
重复经颅磁刺激（rTMS）与高比例参与者的线圈下的显著头皮不适相关，特别是高刺激强度（100%运动阈值或更高）或频率（1 Hz或更高）。在rTMS临床试验中，一些患者无法忍受疼痛并退出。似乎没有发表的研究策略，以减少局部疼痛和不适与rTMS。因此，作者对4种不同的策略进行了初步的试点试验，以管理与左前额叶rTMS相关的不适。健康成年人评定左前额叶rTMS的疼痛和不愉快（10 Hz; 5秒，开启; 30秒，关闭;在静息运动阈值的100%和120%）之前和之后（1）局部应用局部麻醉剂乳膏的低共熔混合物，（2）头皮注射利多卡因，（3）头皮注射利多卡因和肾上腺素，以及（4）在线圈和头皮之间具有或不具有3 × 3英寸的薄泡沫片。将rTMS在这些实验条件下产生的不适与在没有干预的情况下以相同参数刺激产生的不适进行比较。局部麻醉剂注射与疼痛强度和不愉快的显着降低相关，而局部麻醉剂乳膏的低共熔混合物对rTMS相关的不适没有影响。使用泡沫板与疼痛强度和不愉快的轻微但明显的降低相关。需要对不同策略减少rTMS相关疼痛和不适的有效性进行更系统的研究。
Repetitive transcranial magnetic stimulation (rTMS) is associated with significant scalp discomfort under the coil for a high percentage of participants, especially with high stimulation intensities (100% of motor threshold or higher) or frequencies (1 Hz or greater). Some patients in rTMS clinical trials have been unable to tolerate the pain and have dropped out. There seem to be no published studies of strategies to reduce the localized pain and discomfort associated with rTMS. Thus, the authors conducted preliminary pilot trials of 4 different strategies for managing discomfort associated with left prefrontal rTMS. Healthy adults rated the painfulness and unpleasantness of left prefrontal rTMS (10 Hz; 5 seconds, on; 30 seconds, off; at 100% and 120% of resting motor threshold) before and after (1) topical application of a eutectic mixture of local anesthetics cream, (2) scalp injection of lidocaine, (3) scalp injection of lidocaine and epinephrine, and (4) with or without 3 x 3-in thin foam sheets between the coil and scalp. The discomfort produced by rTMS under these experimental conditions was compared with the discomfort produced by stimulation with the same parameters without the interventions. Localized anesthetic injections were associated with a significant decrease in pain intensity and unpleasantness, whereas the eutectic mixture of local anesthetics cream had no effect on rTMS-related discomfort. The use of foam sheets was associated with a slight but noticeable decrease in pain intensity and unpleasantness. More systematic research is needed on the effectiveness of different strategies for reducing rTMS-related pain and discomfort.