Thomas Joy, Fauchon Camille, Oriol Nicolas, Vassal François, Créac'h Christelle, Quesada Charles, Peyron Roland
Inserm U1028 Neuropain, Université Jean-Monnet, F-42023, Saint-Etienne and Centre de Recherche en Neurosciences de Lyon (CRNL) UMR5292, Saint-Etienne et Lyon, France.
Centre Stéphanois de la Douleur et Département de Neurologie, Centre Hospitalier Régional Universitaire de Saint-Etienne, Saint-Etienne, France.
Eur J Pain. 2025 Jan;29(1):e4763. doi: 10.1002/ejp.4763.
Current clinical trials indicate that repetitive transcranial magnetic stimulation (rTMS) is effective in reducing drug-resistant neuropathic pain (NP). However, there is a lack of studies evaluating the long-term feasibility and clinical efficacy of rTMS in large patient cohorts in real-world conditions.
In this retrospective cohort study, we analysed 12 years of clinical data to assess the long-term analgesic effects of 20 Hz rTMS over the primary motor cortex in patients with NP. Subgroup analyses were conducted to identify predictive factors and assess the potential role of epidural motor cortex stimulation (eMCS) as a sustained solution.
In total, 193 patients completed test period of 4 rTMS sessions and 42% of them reported a pain relief (PR) greater than 30%, with concurrent improvement in their most disabling symptom. Iterative rTMS sessions maintained analgesic effects over 10 years in certain patients identified as responders (≥10% PR) without adverse effects. Success probability was higher in patients with central NP compared to peripheral NP (OR = 2.03[1.04;4.00]), and among those with central post-stroke pain, this probability was higher in ischemic versus hemorrhagic strokes (OR = 3.36[1.17;10.05]). PR obtained with iterative rTMS sessions was an excellent predictor of eMCS efficacy.
While rTMS shows promise as a therapeutic option for some patients with drug-resistant NP, it does not benefit all patients. Efficacy varies by NP aetiology, aiding patient selection. For responders, eMCS may offer a permanent solution. These findings support a tailored approach to rTMS in NP management, while recognizing both its potential and limitations across diverse patient profiles.
Multiple rTMS sessions demonstrate long-term efficacy and safety in treating drug-resistant neuropathic pain. Extending session numbers for the test period can enhance responder identification, especially in patients with initial low pain relief. This identification refines patient selection for neurosurgery, reducing non-responders. Central neuropathic pain shows higher success rates than peripheral. For post-stroke central pain, patients with ischemic stroke are more likely to respond than those with hemorrhagic stroke. These results support integrating rTMS into clinical practice for managing neuropathic pain.
目前的临床试验表明，重复经颅磁刺激（rTMS）在减轻耐药性神经性疼痛（NP）方面有效。然而，缺乏在真实世界条件下对大量患者队列评估rTMS长期可行性和临床疗效的研究。
在这项回顾性队列研究中，我们分析了12年的临床数据，以评估20Hz rTMS对NP患者初级运动皮层的长期镇痛效果。进行亚组分析以确定预测因素，并评估硬膜外运动皮层刺激（eMCS）作为一种持久解决方案的潜在作用。
总共193名患者完成了4次rTMS治疗的测试期，其中42%的患者报告疼痛缓解（PR）大于30%，同时其最致残症状也有所改善。在某些被确定为有反应者（PR≥10%）的患者中，重复的rTMS治疗在10年期间维持了镇痛效果且无不良反应。与周围性NP患者相比，中枢性NP患者的成功概率更高（OR = 2.03[1.04;4.00]），而在中风后中枢性疼痛患者中，缺血性中风患者的成功概率高于出血性中风患者（OR = 3.36[1.17;10.05]）。重复rTMS治疗获得的PR是eMCS疗效的良好预测指标。
虽然rTMS对一些耐药性NP患者显示出作为一种治疗选择的前景，但并非对所有患者都有益。疗效因NP病因而异，有助于患者选择。对于有反应者，eMCS可能提供一种永久性解决方案。这些发现支持在NP管理中对rTMS采取量身定制的方法，同时认识到其在不同患者群体中的潜力和局限性。
多次rTMS治疗在治疗耐药性神经性疼痛方面显示出长期疗效和安全性。延长测试期的治疗次数可以提高有反应者的识别率，特别是在初始疼痛缓解较低的患者中。这种识别优化了神经外科手术的患者选择，减少无反应者。中枢性神经性疼痛的成功率高于周围性。对于中风后中枢性疼痛，缺血性中风患者比出血性中风患者更可能有反应。这些结果支持将rTMS纳入临床实践以管理神经性疼痛。
