Pain Research Institute, Clinical Sciences Centre, Liverpool, UK.
Neuromodulation. 2014 Dec;17(8):731-6; discussion 736. doi: 10.1111/ner.12198. Epub 2014 Jun 17.
To quantify changes in pain and somatosensory function in patients with central poststroke pain (CPSP) syndrome following five sessions of repetitive transcranial magnetic stimulation (rTMS).
Fourteen CPSP patients underwent MRI-guided TMS mapping to identify the motor hotspot for evoked responses from a muscle corresponding to a painful region (hand, N = 11, or distal leg, N = 3). Targeted rTMS consisting of 2000 stimuli/10 Hz each session was delivered over five sessions. Quantitative somatosensory testing (QST) was performed within the painful area and at the contralateral mirror-image site at baseline and after the rTMS.
At baseline there were significant sensory deficits of the affected body side for warm and cold detection and heat/cold pain thresholds. Following rTMS, sensory thresholds showed significant improvements for cold detection threshold (repeated-measures ANOVA, p = 0.04). Subjects' pain reports (numerical rating scale 0-10) showed modest but significant improvements in the first week after rTMS (baseline 7.0 ± 1.5; post-TMS 6.3 ± 1.5; Wilcoxon signed-rank test, p = 0.018), and these were largely maintained for up to four weeks post-rTMS. Improvements in warm detection threshold showed a significant correlation with decrease in pain score (Spearman's rank-order correlation, p = 0.007).
Five sessions of open-label rTMS provided analgesia and improved thermal sensibility. The correlation of reduction of detection threshold for warmth and pain relief suggest that the effect of rTMS may be mediated via circuitries that share the processing of noxious and thermal signals, such as the insula and the somatosensory and anterior cingulate cortices. QST may have a role in the assessment of patients with neuropathic pain for suitability for rTMS treatment and is likely to add to our understanding of how rTMS induces pain relief.
量化重复经颅磁刺激（rTMS）五次治疗后，中枢性卒中后疼痛（CPSP）综合征患者疼痛和躯体感觉功能的变化。
14 例 CPSP 患者接受 MRI 引导 TMS 映射，以识别来自对应疼痛区域肌肉的诱发电反应的运动热点（手，N=11，或远端腿部，N=3）。每个疗程 2000 次刺激/10Hz 的靶向 rTMS 共进行五次疗程。在基线和 rTMS 后，在疼痛区域和对侧镜像部位进行定量感觉测试（QST）。
基线时，患侧的温暖和寒冷感觉检测以及热/冷痛觉阈值存在明显的感觉缺陷。rTMS 后，冷觉检测阈值明显改善（重复测量方差分析，p=0.04）。患者的疼痛报告（数字评分量表 0-10）在 rTMS 后第一周有适度但显著的改善（基线 7.0±1.5；rTMS 后 6.3±1.5；Wilcoxon 符号秩检验，p=0.018），并且在 rTMS 后长达四周内基本保持不变。温觉检测阈值的改善与疼痛评分的降低呈显著相关（Spearman 等级相关，p=0.007）。
五次开放性 rTMS 治疗提供了镇痛作用，并改善了热感觉敏感性。检测阈值的降低与疼痛缓解的相关性表明，rTMS 的作用可能是通过共享伤害性和热信号处理的回路来介导的，如岛叶和躯体感觉及前扣带回皮质。QST 可能在评估适合 rTMS 治疗的神经性疼痛患者方面具有作用，并且可能有助于我们了解 rTMS 如何引起疼痛缓解。
