Calabrò Rocco Salvatore, Billeri Luana, Porcari Bruno, Pignolo Loris, Naro Antonino
Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Via Palermo-SS113-Cd.a Casazza, 98121 Messina, Italy.
Istituto Clinico Polispecialistico C.O.T., Cure Ortopediche Traumatologiche s.p.a., Via Ducezio 1, 98100 Messina, Italy.
Brain Sci. 2022 Mar 15;12(3):396. doi: 10.3390/brainsci12030396.
Chronic pelvic pain syndrome (CPPS) affects about 4-16% of adult women, and about one-third of them require medical assistance due to severe symptoms. Repetitive transcranial magnetic stimulation (rTMS) over the supplementary motor area (SMA) has been shown to manage pain in refractory CPPS. Focal muscle vibration (FMV) has also been reported to relieve pelvic pain. The objective of this study was to assess the feasibility and effect of rTMS coupled with FMV to reduce pain in seven adult women with refractory CPPS. This pilot, open-labeled, prospective trial examined treatment by 5 Hz rTMS over SMA and 150 Hz FMV over the perineum, suprapubic, and sacrococcygeal areas, with one daily session for five consecutive days for three weeks. We assessed tolerance and subjective pain changes (as per visual analog scale, VAS) until one month post-treatment, with a primary endpoint at day 7. No patients experienced serious adverse effects or a significant increase in pain. Six out of seven patients experienced a VAS improvement of at least 10% at T7; three of these individuals experienced a VAS improvement of more than 30%. Overall, we found a significant VAS reduction of 15 points (95% CI 8.4-21.6) at T7 (t = 6.3, = 0.001; ES = 2.3 (1.1-3.9)). Three of the women who demonstrated a significant VAS reduction at T7 retained such VAS improvement at T30. VAS decreased by six points (95% CI 1.3-10.7) at T30 (t = 3.1, = 0.02; ES = 1.5 (0.2-2.6)). This coupled approach seems promising for pain management in adult women with refractory CPPS and paves the way for future randomized controlled trials.
慢性盆腔疼痛综合征（CPPS）影响约4% - 16%的成年女性，其中约三分之一因症状严重而需要医疗救助。经颅磁刺激（rTMS）作用于辅助运动区（SMA）已被证明可缓解难治性CPPS的疼痛。局部肌肉振动（FMV）也被报道可减轻盆腔疼痛。本研究的目的是评估rTMS联合FMV减轻7名难治性CPPS成年女性疼痛的可行性和效果。这项先导性、开放标签的前瞻性试验采用5 Hz rTMS作用于SMA以及150 Hz FMV作用于会阴、耻骨上和骶尾区域进行治疗，每天一次，连续五天，共三周。我们评估了耐受性和主观疼痛变化（根据视觉模拟量表，VAS）直至治疗后一个月，主要终点为第7天。没有患者出现严重不良反应或疼痛显著增加。7名患者中有6名在第7天VAS改善至少10%；其中3名患者VAS改善超过30%。总体而言，我们发现第7天VAS显著降低15分（95% CI 8.4 - 21.6）（t = 6.3，P = 0.001；效应量ES = 2.3（1.1 - 3.9））。在第7天VAS显著降低的3名女性在第30天仍保持VAS改善。第30天VAS降低6分（95% CI 1.3 - 10.7）（t = 3.1，P = 0.02；效应量ES = 1.5（0.2 - 2.6））。这种联合方法在难治性CPPS成年女性的疼痛管理方面似乎很有前景，并为未来的随机对照试验铺平了道路。
