Department of Neurosurgery, University of Illinois at Chicago, 912 South Wood Street, 451-N NPI, (MC 799), Chicago, IL, 60612, USA.
Federal Neurosurgical Center of Novosibirsk, Novosibirsk, Russian Federation.
Curr Pain Headache Rep. 2018 May 23;22(6):45. doi: 10.1007/s11916-018-0697-1.
Since the early 1990s, motor cortex stimulation (MCS) has been a unique treatment modality for patients with drug-resistant deafferentation pain. While underpowered studies and case reports have limited definitive, data-driven analysis of MCS in the past, recent research has brought new clarity to the MCS literature and has helped identify appropriate indications for MCS and its long-term efficacy.
In this review, new research in MCS, repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS) are analyzed and compared with historical landmark papers. Currently, MCS is effective in providing relief to 40-64% of patients, with decreasing analgesic effect over time addressed by altering stimulation settings. rTMS and tDCS, two historic, non-invasive stimulation techniques, are providing new alternatives for the treatment of deafferentation pain, with rTMS finding utility in identifying MCS responders. Future advances in electrode arrays, neuro-navigation, and high-definition tDCS hold promise in providing pain relief to growing numbers of patients. Deafferentation pain is severe, disabling, and remains a challenge for patients and providers alike. Over the last several years, the MCS literature has been revitalized with studies and meta-analyses demonstrating MCS effectiveness and providing guidance in identifying responders. At the same time, rTMS and tDCS, two time-honored non-invasive stimulation techniques, are finding new utility in managing deafferentation pain and identifying good MCS candidates. As the number of potential therapies grow, the clinician's role is shifting to personalizing treatment to the unique pain of each patient. With new treatment modalities, this form of personalized medicine is more possible than ever before.
自 20 世纪 90 年代初以来，运动皮层刺激（MCS）一直是治疗感觉丧失性疼痛的耐药患者的独特治疗方法。虽然过去研究力量不足的研究和病例报告限制了对 MCS 的明确、数据驱动的分析，但最近的研究为 MCS 文献带来了新的清晰度，并有助于确定 MCS 的适当适应症及其长期疗效。
在这篇综述中，对 MCS、重复经颅磁刺激（rTMS）和经颅直流电刺激（tDCS）的新研究进行了分析，并与历史标志性论文进行了比较。目前，MCS 对 40-64%的患者有效，通过改变刺激设置可以缓解随着时间推移而降低的镇痛效果。rTMS 和 tDCS 是两种历史悠久的非侵入性刺激技术，为治疗感觉丧失性疼痛提供了新的选择，rTMS 发现可用于识别 MCS 应答者。电极阵列、神经导航和高清晰度 tDCS 的未来进展有望为数以千计的患者提供缓解疼痛的方法。感觉丧失性疼痛是严重的、致残的，仍然是患者和提供者的共同挑战。在过去几年中，MCS 文献通过研究和荟萃分析得到了更新，这些研究和荟萃分析证明了 MCS 的有效性，并提供了识别应答者的指导。与此同时，rTMS 和 tDCS 这两种历史悠久的非侵入性刺激技术在管理感觉丧失性疼痛和识别良好的 MCS 候选者方面找到了新的用途。随着潜在治疗方法的增加，临床医生的角色正在转变为根据每个患者的独特疼痛来个性化治疗。随着新的治疗方法的出现，这种形式的个性化医疗比以往任何时候都更加可行。
