Department of Clinical Neurophysiology, Georg-August University, Göttingen, Germany.
Restor Neurol Neurosci. 2010;28(4):477-84. doi: 10.3233/RNN-2010-0555.
Transcranial stimulation of the primary motor cortex (M1) for the treatment of pain has attracted much interest in recent years. Non-invasive low frequency and high frequency repetitive transcranial magnetic stimulation (rTMS) over the M1 was reported to reduce both experimentally induced acute and chronic pain. In this paper we summarize the results of several studies from our laboratory and report the antinociceptive effects of a special rTMS paradigm, theta-burst stimulation (TBS). We have applied excitatory (iTBS) and inhibitory (cTBS) paradigms over two cortical locations (M1 and the primary somatosensory cortex (S1)). As evaluation criteria a pain rating scale and the recording of laser evoked potentials (LEPs) were used. Reduced subjective pain perception after cTBS could be objectified by alterations of LEPs that reflect pain related activations in the pain processing in the operculo-insular and anterior cingulate cortex. The stimulation of S1 had physiological effects (LEPs), but did not induce significant reduction in acute pain perception. We believe that the application of cTBS over M1 in pain research has a great potential and as a method it can contribute to a more efficient manipulation of the brain plasticity for therapeutic purposes, for example in chronic pain. Nevertheless, the effectiveness of other types of TBS paradigms should also be tested.
近年来，经颅刺激初级运动皮层（M1）治疗疼痛引起了广泛关注。有报道称，非侵入性的低频和高频重复经颅磁刺激（rTMS）可减轻实验诱导的急性和慢性疼痛。本文总结了我们实验室的几项研究结果，并报告了一种特殊 rTMS 范式——θ爆发刺激（TBS）的镇痛效果。我们在两个皮质区域（M1 和初级体感皮层（S1））应用了兴奋性（iTBS）和抑制性（cTBS）范式。评估标准是疼痛评分量表和激光诱发电位（LEP）的记录。cTBS 后主观疼痛感知降低可以通过 LEP 的改变来客观化，LEP 反映了在顶下小叶和前扣带皮层的疼痛处理中的疼痛相关激活。S1 的刺激具有生理效应（LEP），但不会显著降低急性疼痛感知。我们相信，M1 上 cTBS 的应用在疼痛研究中有很大的潜力，并且作为一种方法，它可以为治疗目的更有效地操纵大脑可塑性做出贡献，例如在慢性疼痛中。然而，也应该测试其他类型的 TBS 范式的有效性。
