Significant analgesic effects of one session of postoperative left prefrontal cortex repetitive transcranial magnetic stimulation: A replication study
Significant analgesic effects of one session of postoperative left prefrontal cortex repetitive transcranial magnetic stimulation: A replication study
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DOI：
10.1016/j.brs.2008.04.002
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发表时间：
2008-04-01
影响因子：
7.7
通讯作者：
George, Mark S.
中科院分区：
文献类型：
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作者：
Borckardt, Jeffrey J.;Reeves, Scott T.;George, Mark S.
在最近一项对20名胃旁路手术患者的初步试验中，对左侧前额叶皮质重复20分钟的经颅磁刺激(TMS)与术后患者控制的吗啡使用减少了40%相关。正如所有新的科学发现一样，尤其是那些可能对临床实践产生影响的发现，可复制性是最重要的。这项研究试图验证这一发现的重复性，并更准确地估计这一短暂干预对术后吗啡使用以及术后疼痛和情绪评分的影响大小。方法20名接受胃分流手术的参与者完成了这项重复和扩展C研究。在手术前和出院时收集贝克抑郁量表和流行病学研究中心抑郁量表评分。手术后立即，参与者被随机分配接受20分钟的真实或假重复TMS(RTMS)(10赫兹，10秒开启，20秒关闭，总共4000次脉冲)。跟踪每个参与者术后住院期间患者控制的吗啡泵的使用情况。此外，每天两次通过视觉模拟评分收集疼痛和INOOD I评分。结果重复了最初术后TMS试验的结果，因为接受假TMS的患者的累积吗啡使用曲线明显陡峭，而接受真实TMS的参与者出院时使用的吗啡比接受假TMS的参与者少35%。在出院的时候。接受真实TMS的受试者使用了42.50毫克的吗啡，而接受假TMS的受试者平均使用了64.88毫克。当原始初步试验的数据与这项复制试验的数据相结合时，在接受真实和虚假TMS的受试者之间观察到累积吗啡使用量的显著差异。总体而言，接受真正TMS的参与者使用的吗啡减少了36%，术后平均疼痛评分显著降低。而且最糟糕的痛苦要比参与者接受假手术更痛苦。此外，接受真实TMS的参与者对他们最糟糕的情绪的评价明显好于接受假TMS的参与者。单次20分钟的TMS对术后疼痛和吗啡使用的影响似乎很大(Cohen‘s d=0.70)，并且具有临床意义，最后，交叉滞后相关分析表明，疼痛的改善伴随着疼痛的改善大约几个小时，支持了术后TMS的止痛效果不是由抗抑郁药物驱动的观点。结论尽管还需要更多的研究来独立地验证这些观察到的效果，但最初的TMS试验的结果是重复的。TMS可能有可能显著提高目前胃旁路手术患者的术后护理标准。对其他外科人群进行进一步研究可能是有必要的。未来的研究应该使用方法学，允许对TMS对术后疼痛的因果影响做出更明确的结论(例如，双盲对照)。在头皮不适方面，与真实TMS相匹配的假刺激)。(C)2008 Elsevier Inc.保留所有权利。
BackgroundIn a recent preliminary trial in 20 patients after gastric bypass Surgery, 20 minutes of repetitive transcranial magnetic stimulation (TMS) over the left prefrontal cortex was associated with a 40% reduction in postoperative patient-controlled morphine use. As is the case with all novel scientific findings, and especially those that might have an impact on clinical practice, replicability is paramount. This study sought to test this finding for replication and to more accurately estimate the effect size of this brief intervention on postoperative morphine use and postoperative pain and mood ratings.MethodsTwenty participants who underwent gastric bypass surgery completed this replication and extension C study. Beck Depression Inventory and Center for Epidemiological Studies Depression scale scores were collected befor surgery and at the time of discharge from the hospital. Immediately after surgery, participants were randomly assigned to receive 20 minutes of real or sham repetitive TMS (rTMS) (10 Hz, 10 seconds-ON, 20 seconds-OFF for a total of 4000 Pulses). Patient-controlled morphine pump usage was tracked throughout each participant's postoperative hospital stay. In addition, pain and inood I ratings were collected via Visual analogue scales twice per day.ResultsFindings from the original postoperative TMS trial were replicated, as cumulative morphine usage curves were significantly steeper among patients receiving sham TMS, and participants receiving real TMS had used 35% less morphine at the time of discharge than participants receiving sham TMS. At the time of discharge. subjects who had received real TMS had used 42.50 mg of morphine, whereas subjects receiving sham TMS had used an average of 64.88 mg. When the data from the original preliminary trial were combined with the data from this replication trial, a significant difference in cumulative morphine usage was observed between Subjects receiving real and sham TMS. Overall, participants who received real TMS used 36% less morphine and had significantly lower ratings of postoperative pain-on-average. and pain-at-its-worst than participants receiving sham. In addition, participants who received real TMS rated their mood-at-its-worst as significantly better than participants receiving sham. The effect of it single 20-minute session of TMS on postoperative pain and morphine use appears to be large (Cohen's d = 0.70) and clinically meaningful, Lastly, cross-lag Correlational analyses indicate that improvements in inood follow improvements in pain by approximately hours, supporting the notion that postoperative analgesic TMS effects are not driven by antidepressant effects.ConclusionsAlthough more research is needed to verify these observed effects independently, findings from the original postoperative TMS trial were replicated. TMS may have the potential to significantly improve current standards of postoperative care among gastric bypass patients. and further Studies may be warranted on other surgical populations. Future investigations should use methodology that permits more definitive Conclusions about Causal effects of TMS on postoperative pain (for example, double-linding. Sham Stimulation that is matched with real TMS with respect to scalp discomfort). (C) 2008 Elsevier Inc. All rights reserved.