Repetitive transcranial magnetic stimulation and transcranial direct-current stimulation in neuropathic pain due to radiculopathy: a randomized sham-controlled comparative study
Repetitive transcranial magnetic stimulation and transcranial direct-current stimulation in neuropathic pain due to radiculopathy: a randomized sham-controlled comparative study
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DOI：
10.1097/j.pain.0000000000000510
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发表时间：
2016-06-01
期刊：
影响因子：
7.4
通讯作者：
Bouhassira, Didier
中科院分区：
文献类型：
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作者：
Attal, Nadine;Ayache, Samar S.;Bouhassira, Didier
没有研究直接比较重复经颅磁刺激(RTMS)和经颅直流电刺激(Tdcs)对神经病理性疼痛(NP)的疗效。在这项双中心随机双盲假对照研究中，我们比较了10赫兹rTMS和阳极2 mA tDCs运动皮质和对侧疼痛区域的假刺激(每天3次)在腰骶神经根病NP患者中的疗效。在每次治疗后和5天后评估平均疼痛强度(主要结果)。次要结果包括上肢的神经病变症状和热痛阈值。我们使用了一种创新的设计，通过将患者随机分配到两组中的一组来最小化偏见：活动rTMS和tDCs组或假rTMS组和tDCs组。对于每个治疗组(活动组或假治疗组)，根据交叉设计再次随机安排疗程的顺序。总共有51名患者被筛选，35名(51%的女性)被随机分组。主动rTMS的疼痛强度明显优于TDCs和Sham(F=2.89和P=0.023)。经颅直流电刺激不优于假刺激，但其镇痛作用与rTMS呈正相关(P=0.046)，提示其共同的作用机制。重复经颅磁刺激可降低冷痛阈值(P=0.006.0 4)，其疗效与其镇痛效果呈正相关(P=0.0 5)。然而，rTMS对个体神经病症状没有影响。因此，rTMS对腰骶神经根病所致的NP患者比tDCs和Sham更有效，并可能调节疼痛的感觉和情感维度。
No study has directly compared the effectiveness of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct-current stimulation (tDCS) in neuropathic pain (NP). In this 2-centre randomised double-blind sham-controlled study, we compared the efficacy of 10-Hz rTMS and anodal 2-mA tDCS of the motor cortex and sham stimulation contralateral to the painful area (3 daily sessions) in patients with NP due to lumbosacral radiculopathy. Average pain intensity (primary outcome) was evaluated after each session and 5 days later. Secondary outcomes included neuropathic symptoms and thermal pain thresholds for the upper limbs. We used an innovative design that minimised bias by randomly assigning patients to 1 of 2 groups: active rTMS and tDCS or sham rTMS and tDCS. For each treatment group (active or sham), the order of the sessions was again randomised according to a crossover design. In total, 51 patients were screened and 35 (51% women) were randomized. Active rTMS was superior to tDCS and sham in pain intensity (F = 2.89 and P = 0.023). Transcranial direct-current stimulation was not superior to sham, but its analgesic effects were correlated to that of rTMS (P = 0.046), suggesting common mechanisms of action. Repetitive transcranial magnetic stimulation lowered cold pain thresholds (P = 0.04) and its effect on cold pain was correlated with its analgesic efficacy (P = 0.006). However, rTMS had no impact on individual neuropathic symptoms. Thus, rTMS is more effective than tDCS and sham in patients with NP due to lumbosacral radiculopathy and may modulate the sensory and affective dimensions of pain.