重复经颅磁刺激治疗慢性神经病理性疼痛

目的探讨重复经颅磁刺激（rTMS）对慢性神经病理性疼痛的疗效和安全性。方法回顾性分析4例慢性神经病理性疼痛病人的资料，其中丘脑痛3例，臂丛神经撕脱伤后疼痛1例，均经正规药物治疗效果欠佳，给予运动皮质10Hz的rTMS（1000次刺激）治疗，每个疗程5d，共3个疗程。分别于治疗前、每个疗程后以及全部疗程结束后1个月、6个月和1年采用视觉模拟疼痛评分（VAS）、汉密尔顿抑郁评分（HAMD）和汉密尔顿焦虑评分（HAMA）来评估疗效。结果全部疗程结束后，疗效满意3例，疗效差l例。疗效满意病人中，随访1年后复发2例。副作用为治疗期间头面部轻度疼痛1例。结论rTMS对部分慢性神经病理性疼痛安全有效．尤其是面部和肢体疼痛的病人。但其疗效不持久，可作为运动皮质电刺激的测试方法。

Repetitive transcranial magnetic stimulation for chronic neuropathic pain

Objective To analyze efficacy and safety of repetitive transcranial magnetic stimulation （rTMS） in patients with chronic neuropathic pain. Methods The data of 4 patients with chronic neuropathic pain （thalamic pain in 3 and pain due to brachial plexus avulsion in 1） were analyzed retrospectively. Three 5-day treatment courses of 10 Hz rTMS （1000 stimulations） were applied to the motor cortex in the 4 patients. The visual analogue scale （VAS）, Hamilton depression scale （HAMD） and Hamilton anxiety scale （HAMA） were used at baseline, after each rTMS treatment period, and 1 month, 6 months, 1 year after therapy. Results After the full course of treatment, 3 patients had a satisfactory outcome and one patient a poor efficacy. The 2 patients recurred at the end of 1-year follow-up. The side effect was mild headache and facial pain 1 case. Conclusion The rTMS can be performed to treat chronic neuropathic pain and may be an effective and safe procedure, especially for those facial pain and limb pain. However, the effect of rTMS is transient, and it may be used a testing method for motor cortex stimulation.