Pommier B, Créac'h C, Beauvieux V, Nuti C, Vassal F, Peyron R
Service de Neurochirurgie, Hôpital Nord, Centre Hospitalier Régional Universitaire de Saint-Etienne, France.
Inserm U1028, Université Claude Bernard Lyon1, France.
Eur J Pain. 2016 Jul;20(6):907-16. doi: 10.1002/ejp.815. Epub 2016 Jan 13.
Repetitive transcranial magnetic stimulation (rTMS) appears as a useful tool to alleviate neuropathic pain but only few data are available for the long-term benefit of this treatment.
Here we report the effects of rTMS sessions, considered as a possible therapy for pain relief after a failure of different medications in patients with central (neuropathic) pain. We review here the prospectively collected data of the first forty patients treated as follow: 20 Hz stimulation delivered over the contralateral primary motor cortex (M1), each 3-4 weeks.
A total of 440 rTMS sessions was collected (mean sessions number: 11, range: 1-37, follow-up 312 days on average, maximum 2.8 years). After four sessions, nine patients (22.5%) discontinued rTMS because of a lack of efficiency (<10% pain-relief). The other 31 patients (77.5%) had a cumulative effect across sessions leading to a mean pain relief of 41% for a duration of 15.6 days. A correlation was observed between pain relief in the first session and long-term pain relief (R = 0.649. p = 5.6*10(-6) ). Both intensity and duration of pain relief were significantly better for patients with persistent laser evoked potentials (LEPs, p = 0.049 and 0.0018). We did not observe any adverse-effects.
These results suggest that repeated sessions of 20 Hz rTMS over M1 are interesting in clinical practice for the treatment of selected patients with central pain. Both the cumulative effects across the first sessions and the long duration of pain-relief should impact further randomized trials that are warranted to conclude formally on rTMS efficiency in central pain.
重复经颅磁刺激（rTMS）似乎是缓解神经性疼痛的一种有用工具，但关于这种治疗的长期益处的可用数据很少。
在此我们报告rTMS治疗的效果，rTMS被视为中枢性（神经性）疼痛患者在不同药物治疗失败后缓解疼痛的一种可能疗法。我们在此回顾前瞻性收集的前40例接受如下治疗患者的数据：在对侧初级运动皮层（M1）进行20赫兹刺激，每3 - 4周一次。
共收集到440次rTMS治疗（平均治疗次数：11次，范围：1 - 37次，平均随访312天，最长2.8年）。4次治疗后，9例患者（22.5%）因无效（疼痛缓解<10%）停止rTMS治疗。其他31例患者（77.5%）在各次治疗中有累积效应，导致平均疼痛缓解41%，持续时间为15.6天。首次治疗时的疼痛缓解与长期疼痛缓解之间存在相关性（R = 0.649，p = 5.6×10⁻⁶）。对于持续存在激光诱发电位（LEP）的患者，疼痛缓解的强度和持续时间均显著更好（p = 0.049和0.0018）。我们未观察到任何不良反应。
这些结果表明，在临床实践中，对选定的中枢性疼痛患者，在M1区重复进行20赫兹rTMS治疗是有意义的。首次治疗的累积效应和疼痛缓解的长时间都应影响进一步的随机试验，这些试验有必要正式得出rTMS治疗中枢性疼痛有效性的结论。
