Saleh Christian, Ilia Tatiani Soultana, Jaszczuk Phillip, Hund-Georgiadis Margret, Walter Anna
Clinic for Neurorehabilitation and Paraplegiology, REHAB Basel, Im Burgfelderhof 40, CH-4055, Basel, Switzerland.
Neurol Sci. 2022 May;43(5):3007-3018. doi: 10.1007/s10072-022-05978-0. Epub 2022 Mar 3.
Neuropathic pain is a clinically relevant complication in individuals with spinal cord injury (SCI). Pharmacological pain treatment is often insufficient and leads to undesirable side effects. Thus, alternative therapeutic approaches such as repetitive transcranial magnetic stimulation (rTMS) are of critical importance. We aimed to evaluate the effectiveness of rTMS in neuropathic pain secondary to SCI.
We conducted a systematic review using the PubMed/MEDLINE, EMBASE, and PsycInfo (via OVID) database up April 2021. Only randomized controlled trials were included. Results regarding the pain intensity scores were pooled using a random-effects model.
The search identified a total of 203 potential articles. Of these, eight randomized controlled trials (RCTs) met the eligibility criteria for qualitative synthesis providing the total data of 141 patients. All studies applied high-frequency rTMS. In seven studies, rTMS was applied over the motor cortex, and in one study over the left dorsolateral prefrontal cortex. Five studies reported a significant improvement in baseline pain scores after treatment, and three studies found a significant difference between sham vs. non-sham stimulation at any time. Six RCTs were included in the quantitative synthesis and showed a significant overall reduction of pain intensity in the rTMS groups compared with the sham groups (mean difference - 0.81, 95%CI - 1.45 to - 0.17).
Our findings indicate that high-frequency rTMS of the primary motor cortex and left dorsolateral prefrontal cortex might be promising stimulation targets for neuropathic pain in SCI.
神经性疼痛是脊髓损伤（SCI）患者临床上的一种相关并发症。药物性疼痛治疗往往不足且会导致不良副作用。因此，诸如重复经颅磁刺激（rTMS）等替代治疗方法至关重要。我们旨在评估rTMS对SCI继发神经性疼痛的有效性。
我们使用PubMed/MEDLINE、EMBASE和PsycInfo（通过OVID）数据库进行了一项截至2021年4月的系统评价。仅纳入随机对照试验。使用随机效应模型汇总疼痛强度评分的结果。
检索共识别出203篇潜在文章。其中，八项随机对照试验（RCT）符合定性综合分析的纳入标准，提供了141例患者的全部数据。所有研究均应用高频rTMS。七项研究在运动皮质上应用rTMS，一项研究在左侧背外侧前额叶皮质上应用rTMS。五项研究报告治疗后基线疼痛评分有显著改善，三项研究发现在任何时间假刺激与非假刺激之间存在显著差异。六项RCT纳入定量综合分析，结果显示与假刺激组相比，rTMS组的疼痛强度总体显著降低（平均差值 -0.81，95%CI -1.45至 -0.17）。
我们的研究结果表明，对初级运动皮质和左侧背外侧前额叶皮质进行高频rTMS可能是SCI神经性疼痛有前景的刺激靶点。
