INSERM U-987, CHU Ambroise Paré, Assistance Publique Hôpitaux de Paris, Boulogne-Billancourt F-92100, France Department of Neurology, Hospital das Clinicas, University of São Paulo, Brazil CHU Hôtel Dieu, Assistance Publique Hôpitaux de Paris, Paris F-75001, France Université Paris Descartes, Paris F-75005, France.
Pain. 2011 Jul;152(7):1478-1485. doi: 10.1016/j.pain.2011.01.034. Epub 2011 Mar 11.
We assessed for the first time the long-term maintenance of repetitive transcranial magnetic stimulation (rTMS)-induced analgesia in patients with chronic widespread pain due to fibromyalgia. Forty consecutive patients were randomly assigned, in a double-blind fashion, to 2 groups: one receiving active rTMS (n=20) and the other, sham stimulation (n=20), applied to the left primary motor cortex. The stimulation protocol consisted of 14 sessions: an "induction phase" of 5 daily sessions followed by a "maintenance phase" of 3 sessions a week apart, 3 sessions a fortnight apart, and 3 sessions a month apart. The primary outcome was average pain intensity over the last 24 hours, measured before each stimulation from day 1 to week 21 and at week 25 (1 month after the last stimulation). Other outcomes measured included quality of life, mood and anxiety, and several parameters of motor cortical excitability. Thirty patients completed the study (14 in the sham stimulation group and 16 in the active stimulation group). Active rTMS significantly reduced pain intensity from day 5 to week 25. These analgesic effects were associated with a long-term improvement in items related to quality of life (including fatigue, morning tiredness, general activity, walking, and sleep) and were directly correlated with changes in intracortical inhibition. In conclusion, these results suggest that TMS may be a valuable and safe new therapeutic option in patients with fibromyalgia.
我们首次评估了重复经颅磁刺激（rTMS）治疗纤维肌痛症所致慢性广泛性疼痛患者的长期镇痛效果。40 例连续患者被随机分为两组，以双盲方式进行：一组接受真刺激 rTMS（n=20），另一组接受假刺激（n=20），刺激部位为左侧初级运动皮层。刺激方案包括 14 个疗程：5 个每日疗程的“诱导期”，接着是每周相隔 3 天、每两周相隔 3 天、每月相隔 3 天的“维持期”。主要结局是在第 1 天至第 21 天以及第 25 周（最后一次刺激后 1 个月）每次刺激前的最后 24 小时平均疼痛强度。其他测量的结局包括生活质量、情绪和焦虑以及运动皮层兴奋性的几个参数。30 例患者完成了研究（假刺激组 14 例，真刺激组 16 例）。真刺激 rTMS 从第 5 天到第 25 周显著降低了疼痛强度。这些镇痛效果与生活质量相关项目的长期改善相关（包括疲劳、早晨疲倦、一般活动、行走和睡眠），并与皮质内抑制的变化直接相关。总之，这些结果表明，TMS 可能是纤维肌痛症患者的一种有价值且安全的新治疗选择。
