重复经颅磁刺激联合加巴喷丁治疗脊髓损伤后神经病理性疼痛的临床观察

目的探讨重复经颅磁刺激（rTMS）联合加巴喷丁治疗脊髓损伤（SCI）后神经病理性疼痛（NP）的临床疗效。 方法纳入苏州瑞盛康复医院神经康复科自2017年1月至2018年12月收治的60例SCI后NP患者，用随机数字表法分为观察组与对照组，每组30例。2组患者均口服加巴喷丁，观察组给予M1区10 Hz的rTMS治疗，对照组给予M1区相同模式、相同音量的声音假刺激，在治疗前和治疗后第1、2、4、6周分别采用视觉模拟评分法（VAS）对疼痛进行评定，治疗前、后采用汉密顿抑郁量表（HAMD）及焦虑量表（HAMA）分别对抑郁程度和焦虑程度评定，同时观察加巴喷丁最大用量和不良反应及TMS治疗不良事件。 结果治疗后第1周，2组患者的VAS评分较治疗前均无明显改善差异无统计学意义（P>0.05），2组患者的VAS评分比较，比较差异无统计学意义（P>0.05）；治疗后第2、4、6周，观察组患者的VAS评分均低于对照组，第6周差异更为显著，差异具有统计学意义（P<0.05）。治疗6周后，观察组患者的HAMD评分和HAMA评分优于对照组，差异具有统计学意义（P<0.05）。 结论加巴喷丁联合rTMS治疗SCI后NP具有较好的临床疗效，能够有效控制疼痛，改善SCI患者的抑郁、焦虑情绪状态以及因疼痛导致的睡眠障碍，具有较好的安全性、可靠性。

Observation of repeated transcranial magnetic stimulation combined with gabapentin in the treatment of neuropathic pain after spinal cord injury

ObjectiveTo investigate the clinical effect of repetitive transcranial magnetic stimulation (rTMS) combined with gabapentin in the treatment of neuropathic pain (NP) after spinal cord injury (SCI). MethodsSixty patients with NP after SCI, admitted to Department of Neurorehabilitation of Suzhou Ruisheng Rehabilitation Hospital from January 2017 to December 2018, were enrolled. They were randomly divided into the experimental group and the control group by each group 30 cases. Both groups were given gabapentin. The experimental group was treated with 10 Hz of rTMS in the M1 area. The control group gave the sham therapy with same pattern and the same volume stimuli in the M1 area. Pain was assessed by visual analogue scale (VAS) before and after treatment at 1, 2, 4, and 6 weeks The Hamilton depression scale (HAMD) and anxiety scale (HAMA) were used before and after treatment and observed the maximum dose of gabapentin, side effects and side effects of TMS. ResultsAt the first week after treatment, the VAS scores of the two groups were not significantly improved (P>0.05), and there was no significant difference between 2 groups (P>0.05). After 2, 4, and 6 weeks of treatment, the VAS scores of the experimental group were lower than those of the control group, especially at the 6^th week (P<0.05). After 6 weeks of treatment, the HAMD score and the HAMA score were better in the experimental group than in the control group (P<0.05). ConclusionrTMS combined with gabapentin has a good clinical effect in treatment of SCI. It can effectively control pain, improve depression, anxiety and sleep disorders caused by pain in SCI patients. The safety and reliability of treatment are good.