Nardone Raffaele, Höller Yvonne, Leis Stefan, Höller Peter, Thon Natasha, Thomschewski Aljoscha, Golaszewski Stefan, Brigo Francesco, Trinka Eugen
J Spinal Cord Med. 2014 Jan;37(1):19-31. doi: 10.1179/2045772313Y.0000000140. Epub 2013 Nov 26.
Past evidence has shown that invasive and non-invasive brain stimulation may be effective for relieving central pain.
To perform a topical review of the literature on brain neurostimulation techniques in patients with chronic neuropathic pain due to traumatic spinal cord injury (SCI) and to assess the current evidence for their therapeutic efficacy.
A MEDLINE search was performed using following terms: "Spinal cord injury", "Neuropathic pain", "Brain stimulation", "Deep brain stimulation" (DBS), "Motor cortex stimulation" (MCS), "Transcranial magnetic stimulation" (TMS), "Transcranial direct current stimulation" (tDCS), "Cranial electrotherapy stimulation" (CES).
Invasive neurostimulation therapies, in particular DBS and epidural MCS, have shown promise as treatments for neuropathic and phantom limb pain. However, the long-term efficacy of DBS is low, while MCS has a relatively higher potential with lesser complications that DBS. Among the non-invasive techniques, there is accumulating evidence that repetitive TMS can produce analgesic effects in healthy subjects undergoing laboratory-induced pain and in chronic pain conditions of various etiologies, at least partially and transiently. Another very safe technique of non-invasive brain stimulation - tDCS - applied over the sensory-motor cortex has been reported to decrease pain sensation and increase pain threshold in healthy subjects. CES has also proved to be effective in managing some types of pain, including neuropathic pain in subjects with SCI.
A number of studies have begun to use non-invasive neuromodulatory techniques therapeutically to relieve neuropathic pain and phantom phenomena in patients with SCI. However, further studies are warranted to corroborate the early findings and confirm different targets and stimulation paradigms. The utility of these protocols in combination with pharmacological approaches should also be explored.
过去的证据表明，侵入性和非侵入性脑刺激可能对缓解中枢性疼痛有效。
对创伤性脊髓损伤（SCI）所致慢性神经性疼痛患者的脑神经刺激技术文献进行专题综述，并评估其治疗效果的现有证据。
使用以下术语在MEDLINE数据库进行检索：“脊髓损伤”、“神经性疼痛”、“脑刺激”、“深部脑刺激”（DBS）、“运动皮层刺激”（MCS）、“经颅磁刺激”（TMS）、“经颅直流电刺激”（tDCS）、“颅电疗法刺激”（CES）。
侵入性神经刺激疗法，尤其是DBS和硬膜外MCS，已显示出作为神经性疼痛和幻肢痛治疗方法的前景。然而，DBS的长期疗效较低，而MCS具有相对较高的潜力，并发症比DBS少。在非侵入性技术中，越来越多的证据表明，重复TMS可以在经历实验室诱导疼痛的健康受试者以及各种病因的慢性疼痛情况下产生镇痛作用，至少部分且短暂有效。另一种非常安全的非侵入性脑刺激技术——tDCS，应用于感觉运动皮层，已报道可降低健康受试者的疼痛感觉并提高疼痛阈值。CES也已被证明对管理某些类型的疼痛有效，包括SCI患者的神经性疼痛。
一些研究已开始在治疗上使用非侵入性神经调节技术来缓解SCI患者的神经性疼痛和幻肢现象。然而，需要进一步研究来证实早期发现并确定不同的靶点和刺激模式。还应探索这些方案与药物治疗方法联合使用的效用。
