Repetitive Transcranial Magnetic Stimulation for Phantom Limb Pain in Land Mine Victims: A Double-Blinded, Randomized, Sham-Controlled Trial

JOURNAL OF PAIN

卷:17

Article

Malavera, Alejandra^1,2  Silva, Federico Arturo¹  Fregni, Felipe²  Carrillo, Sandra¹  Garcia, Ronald G.^1,3,4 

[1] Fdn Cardiovasc Colombia, Neurovasc Sci Grp, Floridablanca, Colombia

[2] Harvard Med Sch, Spaulding Rehabil Hosp, Spaulding Neuromodulat Ctr, Boston, MA USA

[3] Univ Santander, Sch Med, MASIRA Res Inst, Bucaramanga, Colombia

[4] Harvard Med Sch, Massachusetts Gen Hosp, Dept Radiol, Martinos Ctr Biomed Imaging, Boston, MA USA

关键词: Phantom limb pain;    land mine victims;    rTMS;    neuropathic pain;    noninvasive brain stimulation;   

DOI  :  10.1016/j.jpain.2016.05.003

来源: Elsevier

【 摘 要 】

We evaluated the effects of repetitive transcranial magnetic stimulation (rTMS) in the treatment of phantom limb pain (PLP) in land mine victims. Fifty-four patients with PLP were enrolled in a randomized, double-blinded, placebo-controlled, parallel group single-center trial. The intervention consisted of real or sham rTMS of M1 contralateral to the amputated leg. rTMS was given in series of 20 trains of 6-second duration (54-second intertrain, intensity 90% of motor threshold) at a stimulation rate of 10 Hz (1,200 pulses), 20 minutes per day, during 10 days. For the control group, a sham coil was used. The administration of active rTMS induced a significantly greater reduction in pain intensity (visual analogue scale scores) 15 days after treatment compared with sham stimulation (-53.38 +/- 53.12% vs -22.93 +/- 57.16%; mean between-group difference = 30.44%, 95% confidence interval, .30-60.58; P = .03). This effect was not significant 30 days after treatment. In addition, 19 subjects (70.3%) attained a clinically significant pain reduction (>30%) in the active group compared with 11 in the sham group (40.7%) 15 days after treatment (P =.03). The administration of 10 Hz rTMS on the contralateral primary motor cortex for 2 weeks in traumatic amputees with PLP induced significant clinical improvement in pain. Perspective: High-frequency rTMS on the contralateral primary motor cortex of traumatic amputees induced a clinically significant pain reduction up to 15 days after treatment without any major secondary effect. These results indicate that rTMS is a safe and effective therapy in patients with PLP caused by land mine explosions. (C) 2016 by the American Pain Society

【 授权许可】

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