Radiansyah Riva Satya, Hadi Deby Wahyuning
Faculty of Medicine and Health, Institut Teknologi Sepuluh Nopember, Surabaya, Indonesia.
Department of Neurology, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
Korean J Pain. 2023 Oct 1;36(4):408-424. doi: 10.3344/kjp.23220.
Central post-stroke pain (CPSP) is an incapacitating disorder that impacts a substantial proportion of stroke survivors and can diminish their quality of life. Conventional therapies for CPSP, including tricyclic antidepressants, anticonvulsants, and opioids, are frequently ineffective, necessitating the investigation of alternative therapeutic strategies. Repetitive transcranial magnetic stimulation (rTMS) is now recognized as a promising noninvasive pain management method for CPSP. rTMS modulates neural activity through the administration of magnetic pulses to specific cortical regions. Trials analyzing the effects of rTMS on CPSP have generated various outcomes, but the evidence suggests possible analgesic benefits. In CPSP and other neuropathic pain conditions, high-frequency rTMS targeting the primary motor cortex (M1) with figure-eight coils has demonstrated significant pain alleviation. Due to its associaton with analgesic benefits, M1 is the most frequently targeted area. The duration and frequency of rTMS sessions, as well as the stimulation intensity, have been studied in an effort to optimize treatment outcomes. The short-term pain relief effects of rTMS have been observed, but the long-term effects (> 3 months) require further investigation. Aspects such as stimulation frequency, location, and treatment period can influence the efficacy of rTMS and ought to be considered while planning the procedure. Standardized guidelines for using rTMS in CPSP would optimize therapy protocols and improve patient outcomes. This review article provides an up-to-date overview of the incidence, clinical characteristics, outcome of rTMS in CPSP patients, and future perspective in the field.
中风后中枢性疼痛(CPSP)是一种使人丧失能力的疾病,影响着很大一部分中风幸存者,并会降低他们的生活质量。CPSP的传统疗法,包括三环类抗抑郁药、抗惊厥药和阿片类药物,往往无效,因此需要研究替代治疗策略。重复经颅磁刺激(rTMS)现在被认为是一种有前景的用于CPSP的非侵入性疼痛管理方法。rTMS通过向特定皮质区域施加磁脉冲来调节神经活动。分析rTMS对CPSP影响的试验产生了各种结果,但证据表明可能有镇痛益处。在CPSP和其他神经性疼痛病症中,使用八字形线圈靶向初级运动皮层(M1)的高频rTMS已显示出显著的疼痛缓解。由于其与镇痛益处相关,M1是最常被靶向的区域。人们对rTMS治疗的持续时间、频率以及刺激强度进行了研究,以优化治疗效果。已观察到rTMS的短期疼痛缓解效果,但长期效果(>3个月)需要进一步研究。刺激频率、位置和治疗时间等方面会影响rTMS的疗效,在规划治疗过程时应予以考虑。在CPSP中使用rTMS的标准化指南将优化治疗方案并改善患者预后。这篇综述文章提供了关于CPSP患者中rTMS的发病率、临床特征、治疗效果以及该领域未来展望的最新概述。