Foglia Stevie D, Drapeau Chloe C, Ramdeo Karishma R, Adams Faith C, Soppitt Daniel B, Rehsi Ravjot S, Shanthanna Harsha, Nelson Aimee J
School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada.
Department of Kinesiology, McMaster University, Hamilton, ON, Canada.
J Pain Res. 2025 Jan 20;18:367-377. doi: 10.2147/JPR.S496519. eCollection 2025.
Complex regional pain syndrome (CRPS) is a debilitating chronic pain condition characterized by sensory, motor, and autonomic dysfunction with a world-wide prevalence of 26.2 per 100,000 people per year and is 3 to 4 times more prevalent in females. Repetitive transcranial magnetic stimulation (rTMS) has shown to be beneficial for pain relief in neuropathic pain and initial evidence in CRPS is promising, but studies are limited. The objective of this study was to investigate the feasibility of using rTMS in CRPS patients, to improve pain intensity and quality of life.
Six participants (5 lower limb, 1 upper limb, 42 ± 9 yr) took part in an open-label rTMS study comprised of a 9-week intervention and 6-month follow-up. Participants took part in a 4-week induction period (5 days per week) followed by a 5-week tapering period whereby the frequency of rTMS sessions per week was reduced. rTMS was delivered at 10 hz for 2000 pulses at 80% of resting motor threshold over the primary motor cortex. Feasibility was assessed as compliance of attending treatment sessions. Clinical outcomes included pain intensity using the numerical ratings scale, Pain Catastrophizing scale-EN-SF, PROMIS-29 v2.0 profile, and Rainbow Pain Scale.
All participants tolerated the study procedures and 83% of participants completed the 9-week intervention, deeming the protocol feasible. At six months follow-up, data was obtained from 3 individuals. Exploratory analysis revealed a significant reduction in pain intensity (~20%) immediately following the intervention. Categorical improvements in allodynia were observed in four patients immediately following the intervention.
This study demonstrates that rTMS delivered over 9 weeks is feasible and well tolerated in individuals living with CRPS. However, there are challenges in collecting follow-up data for six months and appropriate measures must be taken in randomized controlled trials to ensure follow-up retention.
复杂性区域疼痛综合征（CRPS）是一种使人衰弱的慢性疼痛病症，其特征为感觉、运动和自主神经功能障碍，全球每年的患病率为每10万人中有26.2例，在女性中的患病率是男性的3至4倍。重复经颅磁刺激（rTMS）已被证明对缓解神经性疼痛有益，并且在CRPS方面的初步证据很有前景，但相关研究有限。本研究的目的是探讨在CRPS患者中使用rTMS的可行性，以改善疼痛强度和生活质量。
六名参与者（5名下肢患者，1名上肢患者，年龄42±9岁）参加了一项开放标签的rTMS研究，该研究包括为期9周的干预和6个月的随访。参与者先参加为期4周的诱导期（每周5天），随后是为期5周的减量期，在此期间每周的rTMS治疗次数减少。rTMS以10赫兹的频率在初级运动皮层上以静息运动阈值的80%给予2000个脉冲。可行性通过参加治疗 sessions 的依从性来评估。临床结果包括使用数字评分量表的疼痛强度、疼痛灾难化量表 - EN - SF、PROMIS - 29 v2.0简表和彩虹疼痛量表。
所有参与者都耐受了研究程序，83%的参与者完成了9周的干预，认为该方案可行。在六个月的随访中，从3名个体获得了数据。探索性分析显示，干预后疼痛强度立即显著降低（约20%）。干预后立即在4名患者中观察到了痛觉过敏的分类改善。
本研究表明，在CRPS患者中进行为期9周的rTMS治疗是可行的且耐受性良好。然而，收集六个月的随访数据存在挑战，在随机对照试验中必须采取适当措施以确保随访保留率。
