Improving functions in Veterans with Post-Traumatic Peripheral Neuropathic Pain

摘要 在退伍军人中，超过30%的神经病理性疼痛状况是由于周围神经损伤而引起的 与手术有关的创伤。周围神经损伤常导致神经瘤/神经卡压的形成。 伴有感觉过敏和无法控制的自发的持续性神经病理性疼痛状态 受伤部位有痛感。目前治疗神经病理性疼痛的现有药物通常包括不适 副作用和/或滥用风险。手术切除或局部注射类固醇等侵入性措施 而损伤/神经瘤部位的局部麻醉剂通常在缓解症状和 侵入性的手术对患者来说通常是痛苦的。因此，在痛苦领域存在着需求 非侵入性和非接触性治疗方法在创伤后救治中的应用 周围神经病理性疼痛(PTP-NP)状态。退伍军人事务部圣地亚哥医疗系统的疼痛服务 注意到在PTP-NP患者中令人鼓舞的疼痛缓解益处。PI还完成了一条机械神经 传导研究表明，这种治疗方法可以潜在地恢复失去的神经元功能 与PTP-NP相关。我们最初的试点数据来自一项随机对照研究，支持 开展更大规模的随机对照临床试验，充分评估TMS的治疗效果 PTP-NP，改善患者功能。验证TMS作为非接触性和非侵入性疼痛治疗的有效性 评估：1)经皮磁刺激(TMS)在减轻创伤后的作用 外周神经病理性疼痛(PTP-NP)；2)TMS对改善患者生活质量和功能的作用 患有PTP-NP的退伍军人。

Abstract Over 30% of neuropathic pain conditions in Veterans are due to peripheral nerve injury from physical or surgical related trauma. Peripheral nerve injury often results in the formation of neuroma/nerve entrapment, a persistent neuropathic pain state accompanied by sensory hypersensitivity and uncontrollable spontaneous pain sensation at the injury site. Current available medications for neuropathic pain often consist of untoward side effects and/or abusive risks. Invasive measures such as surgical resection or local injections of steroid and local anesthetics at the injury/neuroma site are often ineffective in alleviating the symptoms and the invasive nature of the procedure is usually painful for the patients. Therefore, there is a need in the field of pain management in developing means of non-invasive and non-contact therapy in treating post-traumatic peripheral neuropathic pain (PTP-NP) states. The pain service at the VA San Diego Healthcare System (VASDHS) has recently adopted the use of transcutaneous magnetic stimulation (tMS) in treating PTP-NP and noticed encouraging pain relief benefit in patients with PTP-NP. The PI also completed a mechanistic nerve conduction study and showed that this treatment method can potentially restore lost neuronal functions associated with PTP-NP. Our initial pilot data from a randomized controlled study support the feasibility of conducting a larger scale randomized controlled clinical trial to adequately assess the effect of tMS in treating PTP-NP and improving patients' function. To validate tMS as a non-contact and non-invasive pain treatment option for reducing pain in Veterans with PTP-NP and improving their overall functions, the proposed study will assess: 1) the effect of transcutaneous magnetic stimulation (tMS) in alleviating post-traumatic peripheral neuropathic pain (PTP-NP); 2) the effect of tMS in improving quality of life and functions in Veterans with PTP-NP.