Shimizu Takeshi, Hosomi Koichi, Maruo Tomoyuki, Goto Yuko, Shimokawa Toshio, Haruhiko Kishima, Saitoh Youichi
Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Department of Neurosurgery, Otemae Hospital, 1-5-34 Otemae, Osaka, Osaka 540-0008, Japan; Center for Pain Management, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan.
Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Center for Pain Management, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan.
J Clin Neurosci. 2018 Jul;53:100-105. doi: 10.1016/j.jocn.2018.04.017. Epub 2018 Apr 23.
Spinal cord stimulation (SCS) is an effective albeit invasive and relatively expensive treatment of neuropathic pain. Repetitive transcranial magnetic stimulation (rTMS) over the primary motor cortex (M1) is a non-invasive treatment of neuropathic pain. The aim of the current study was to investigate whether rTMS can predict the successful outcome of SCS.
The study population consisted of 22 patients with neuropathic pain who had undergone SCS and rTMS. We conducted statistical analyses to identify the factors that predict pain reduction following SCS.
Multiple regression analyses showed that only degree of pain relief following rTMS was statistically correlated with success in SCS; on the other hand, age, sex, lesion location, pain duration and laterality, and targeted extremities were not correlated. Using receiver-operating characteristic (ROC) curve analyses of the pain relief following rTMS, the diagnostic sensitivity for successful SCS was 0.60 and the specificity was 0.83.
The degree of pain relief following rTMS over M1 is a significant prognostic factor of SCS outcome in patients with intractable neuropathic pain.
The current study provides evidence showing that rTMS, a non-invasive and relatively easy to administer procedure, may aid in the selection of suitable candidates for SCS treatment.
脊髓刺激（SCS）是一种治疗神经性疼痛的有效方法，尽管具有侵入性且相对昂贵。对初级运动皮层（M1）进行重复经颅磁刺激（rTMS）是一种治疗神经性疼痛的非侵入性方法。本研究的目的是调查rTMS是否能够预测SCS的成功结果。
研究对象包括22例接受过SCS和rTMS治疗的神经性疼痛患者。我们进行了统计分析，以确定预测SCS后疼痛减轻的因素。
多元回归分析表明，只有rTMS后的疼痛缓解程度与SCS的成功具有统计学相关性；另一方面，年龄、性别、病变位置、疼痛持续时间和偏侧性以及目标肢体均无相关性。通过对rTMS后疼痛缓解情况进行受试者工作特征（ROC）曲线分析，成功SCS的诊断敏感性为0.60，特异性为0.83。
对M1进行rTMS后的疼痛缓解程度是难治性神经性疼痛患者SCS结果的一个重要预后因素。
本研究提供的证据表明，rTMS这种非侵入性且相对易于实施的程序，可能有助于选择适合SCS治疗的患者。
