INSERM U-987, Centre d'Evaluation et de Traitement de la Douleur, CHU Ambroise Paré, Assistance Publique Hôpitaux de Paris, F-92100 Boulogne Billancourt, France; Clermont Université, Université d'Auvergne, Neuro-Dol, Inserm U-1107, F-63000 Clermont-Ferrand, France; Clermont Université, Université d'Auvergne, Service de Neurologie, CHU Gabriel Montpied, F-63000 Clermont-Ferrand, France.
INSERM U-987, Centre d'Evaluation et de Traitement de la Douleur, CHU Ambroise Paré, Assistance Publique Hôpitaux de Paris, F-92100 Boulogne Billancourt, France; Faculté de pharmacie, Université de Poitiers, France.
Brain Stimul. 2015 Jan-Feb;8(1):135-41. doi: 10.1016/j.brs.2014.10.006. Epub 2014 Oct 18.
Repetitive transcranial magnetic stimulation (rTMS) of the primary motor cortex (M1) at high frequency (>5 Hz) induces analgesic effects, probably by activating pain modulation systems. A new rTMS paradigm--theta burst stimulation (TBS)--consists of bursts of three pulses at 50 Hz repeated five times per second. Like high frequency rTMS, both intermittent and prolonged continuous TBS (iTBS and pcTBS) lead to a facilitation of cortical excitability.
(1) to evaluate the analgesic effects of neuronavigated iTBS and pcTBS, comparing them with those of classical high frequency rTMS (10 Hz) over the left M1, (2) to elucidate the role of conditioned pain modulation (CPM) in the antinociceptive effect of rTMS and (3) to investigate possible correlations between analgesia and cortical excitability.
Fourteen healthy volunteers participated in four experimental sessions, carried out in a random order (iTBS, pcTBS, 10 Hz rTMS or sham). Cold pain threshold, CPM and cortical excitability measurements were carried out before and after rTMS.
We found that the analgesic effects of 10 Hz rTMS and pcTBS were significantly superior to those of sham rTMS. Moreover, pcTBS was significantly more effective than 10 Hz rTMS (P = 0.026). Analgesia did not seem to be driven by changes in CPM or cortical excitability.
Prolonged cTBS has considerable clinical potential, as it has a shorter treatment duration (by a factor 8) and stronger analgesic effects than the classical high frequency protocol. Studies in patients are required to confirm the potential of this new stimulation paradigm for clinical applications.
高频重复经颅磁刺激（rTMS）（>5Hz）刺激初级运动皮层（M1）可产生镇痛作用，可能是通过激活疼痛调节系统。一种新的 rTMS 模式——theta 爆发刺激（TBS）——由 50Hz 的三个脉冲组成，每秒重复五次。与高频 rTMS 一样，间歇性和持续性连续 TBS（iTBS 和 pcTBS）都会导致皮质兴奋性增强。
（1）评估经颅磁刺激导航 iTBS 和 pcTBS 的镇痛效果，将其与左 M1 上的经典高频 rTMS（10Hz）进行比较，（2）阐明条件性疼痛调制（CPM）在 rTMS 镇痛作用中的作用，（3）研究镇痛作用与皮质兴奋性之间的可能相关性。
14 名健康志愿者参与了四个实验，按随机顺序进行（iTBS、pcTBS、10Hz rTMS 或假刺激）。在 rTMS 前后进行冷痛阈值、CPM 和皮质兴奋性测量。
我们发现 10Hz rTMS 和 pcTBS 的镇痛效果明显优于假刺激 rTMS。此外，pcTBS 的效果明显优于 10Hz rTMS（P=0.026）。镇痛似乎不是由 CPM 或皮质兴奋性的变化引起的。
持续性 cTBS 具有相当大的临床潜力，因为它的治疗时间（缩短了 8 倍）比经典高频方案更短，镇痛效果更强。需要对患者进行研究以确认这种新刺激模式在临床应用中的潜力。
