Neurogenic pain relief by repetitive transcranial magnetic cortical stimulation depends on the origin and the site of pain
Neurogenic pain relief by repetitive transcranial magnetic cortical stimulation depends on the origin and the site of pain
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DOI：
10.1136/jnnp.2003.022236
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发表时间：
2004-04-01
影响因子：
11
通讯作者：
Nguyen, JP
中科院分区：
文献类型：
--
作者：
Lefaucheur, JP;Drouot, X;Nguyen, JP
目的：重复经颅磁刺激（rTMS）运动皮层可缓解耐药神经源性疼痛。本研究的目的是评估疼痛的起源，疼痛的网站，感觉损失的影响rTMS efficient.Patients和方法：60名右手患者，患有顽固性疼痛继发于以下类型的病变之一：丘脑中风，脑干中风，脊髓病变，臂丛神经病变，或三叉神经病变。疼痛主要发生在单侧面部、上肢或下肢。在疼痛区内测量热感觉阈值，发现其高度或中度升高。最后，在对应于疼痛侧的手的运动皮层的一侧上的“真实的”或“假的”10 Hz rTMS的20分钟会话之前和之后，在视觉模拟量表上对疼痛水平进行评分，即使手本身没有经历疼痛。真实的rTMS后的疼痛减轻百分比显著大于假rTMS（-22.9%v-7.8%，p = 0.0002），证实运动皮层rTMS能够诱导镇痛作用。这些影响显着影响的起源和疼痛的网站。对于疼痛起源，结果在脑干卒中患者中更差，无论疼痛部位如何。这与脑干内由运动皮质丘脑输出触发的下行调制一致。对于疼痛部位，虽然刺激针对手部皮质区，但面部疼痛获得了更好的结果。因此，与植入刺激相比，rTMS程序在疼痛控制中的目标可能不是与疼痛区相对应的区域，而是相邻的区域。由传入神经阻滞引起的皮层区域的跨表征可塑性可以解释这种差异。最后，感觉丧失的程度并没有干扰疼痛的起源或疼痛部位有关rTMS effects.Conclusion：运动皮层rTMS被认为是导致一个显着的，但短暂的缓解慢性疼痛，疼痛的起源和疼痛部位的影响。这些参数应考虑在任何进一步的研究rTMS应用于慢性疼痛控制。
Objective: Drug resistant neurogenic pain can be relieved by repetitive transcranial magnetic stimulation (rTMS) of the motor cortex. This study was designed to assess the influence of pain origin, pain site, and sensory loss on rTMS efficacy.Patients and methods: Sixty right handed patients were included, suffering from intractable pain secondary to one of the following types of lesion: thalamic stroke, brainstem stroke, spinal cord lesion, brachial plexus lesion, or trigeminal nerve lesion. The pain predominated unilaterally in the face, the upper limb, or the lower limb. The thermal sensory thresholds were measured within the painful zone and were found to be highly or moderately elevated. Finally, the pain level was scored on a visual analogue scale before and after a 20 minute session of "real" or "sham" 10 Hz rTMS over the side of the motor cortex corresponding to the hand on the painful side, even if the pain was not experienced in the hand itself.Results and discussion: The percentage pain reduction was significantly greater following real than sham rTMS (-22.9% v -7.8%, p = 0.0002), confirming that motor cortex rTMS was able to induce antalgic effects. These effects were significantly influenced by the origin and the site of pain. For pain origin, results were worse in patients with brainstem stroke, whatever the site of pain. This was consistent with a descending modulation within the brainstem, triggered by the motor corticothalamic output. For pain site, better results were obtained for facial pain, although stimulation was targeted on the hand cortical area. Thus, in contrast to implanted stimulation, the target for rTMS procedure in pain control may not be the area corresponding to the painful zone but an adjacent one. Across representation plasticity of cortical areas resulting from deafferentation could explain this discrepancy. Finally, the degree of sensory loss did not interfere with pain origin or pain site regarding rTMS effects.Conclusion: Motor cortex rTMS was found to result in a significant but transient relief of chronic pain, influenced by pain origin and pain site. These parameters should be taken into account in any further study of rTMS application in chronic pain control.