Ahmed Mohamed A, Mohamed Sahar A, Sayed Douaa
Neurology Department, Assiut University Hospital, Egypt.
Neurol Res. 2011 Nov;33(9):953-8. doi: 10.1179/1743132811Y.0000000045.
To assess the long-term analgesic effect of repetitive transcranial stimulation (rTMS) on chronic phantom pain using high frequency stimulation and to measure the serum beta-endorphin level pre- and post-rTMS.
The study included 27 patients with unilateral amputation; all patients had chronic phantom pain. The patients were classified into two groups. Seventeen patients received 10 minutes real rTMS over the hand area of motor cortex (20 Hz, 10 second trains, intensity 80% of motor threshold) every day for five consecutive days and 10 patients received sham stimulation. Pain was assessed using a visual analogue scale (VAS) and the Leeds assessment of neuropathic symptoms and signs (LANSS) scale, before and after the first, fifth sessions, one and two months after the last session. Quantitative determination of serum beta-endorphin before and after five sessions was measured.
There was no significant difference between true and sham groups in the duration of illness, VAS, LANSS scores and resting motor threshold in upper and lower limb amputation at the base line. VAS and LANS scores of the patients who received real rTMS decreased more over the course of the treatment through the different points of follow-up (after five sessions, one and two months) than those who received sham stimulation. Serum beta-endorphin was increased significantly after real stimulation with no changes in patients received shame. Serum beta-endorphin showed no significant correlation to Hamilton depression, anxiety, VAS and LANS scores in true or sham groups before or after five sessions for rTMS.
These results confirm that five daily sessions of rTMS over motor cortex can produce long lasting pain relief in patients with phantom pain and it might be related to an elevation of serum beta-endorphin concentration.
采用高频刺激评估重复经颅磁刺激（rTMS）对慢性幻肢痛的长期镇痛效果，并测量rTMS前后血清β-内啡肽水平。
本研究纳入27例单侧截肢患者；所有患者均患有慢性幻肢痛。将患者分为两组。17例患者连续5天每天在运动皮层手部区域接受10分钟的真实rTMS（20Hz，10秒串，强度为运动阈值的80%），10例患者接受假刺激。在第一次、第五次治疗前和治疗后，以及最后一次治疗后1个月和2个月，使用视觉模拟量表（VAS）和利兹神经病理性症状和体征评估（LANSS）量表评估疼痛。测量五次治疗前后血清β-内啡肽的定量测定。
在基线时，真刺激组和假刺激组在病程、VAS、LANSS评分以及上肢和下肢截肢的静息运动阈值方面无显著差异。在整个治疗过程中，通过不同的随访点（五次治疗后、1个月和2个月），接受真实rTMS的患者的VAS和LANS评分下降幅度比接受假刺激的患者更大。真实刺激后血清β-内啡肽显著升高，接受假刺激的患者无变化。在rTMS五次治疗前后，血清β-内啡肽在真刺激组或假刺激组中与汉密尔顿抑郁、焦虑、VAS和LANS评分均无显著相关性。
这些结果证实，每天在运动皮层进行五次rTMS治疗可使幻肢痛患者获得持久的疼痛缓解，这可能与血清β-内啡肽浓度升高有关。
