Repetitive transcranial magnetic stimulation use in neuropathic pain with comorbid depression: a review of efficient treatment protocols’ parameters

IF 3.2 4区 医学 Q2 CLINICAL NEUROLOGY
D. S. Astafyeva, Y. V. Vlasov, A. Strelnik, O. Chigareva, E. A. Markina, T. Shishkovskaya, D. Smirnova, A. Gayduk
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Abstract

Neuropathic pain affects 7 % of the general population worldwide, it is often resistant to analgesic treatments and is complicated with depressive states in 57–65 % of this patients’ cohort. Ongoing research of current therapeutic approaches, including repetitive transcranial magnetic stimulation (rTMS) use in neuropathic pain and depression, grants new data about the details of treatment protocols’ designs. The aim of our literature review was to evaluate those parameters of the treatment protocols which proved significant efficacy in the management of the neuropathic pain with comorbid depression.Focusing on the Scopus, Elsevier and PubMed databases search, we have found 639 peer‑review articles. 23 studies have been included into the data analysis, whereas others were excluded based on their heterogeneous study design. Across the data analysis we evaluated such rTMS parameters as the type of a coil, type of stimulation area, locus of gained evoked motor potential, amplitude of stimulation, duration of session, frequency/number of sessions per day/month, tie duration between sessions, number and frequency of trains, amount and frequency of pulses containing and efficacy of treatment. Those studies that performed repetitive transcranial magnetic stimulation using the figure‑of‑8 coil over the M1 brain area, for 10 or more daily sessions with duration from 7 up to 40 minutes, of 10–20 Hz frequency, intensity 80–90 % of resting motor threshold and total pulses number over 1500 per session demonstrated the greater efficacy in pain level decrease and depression scores reduction among neuropathic pain patients with comorbid depression. Conducting an additional maintenance phase of treatment prolonged the therapeutic effect of the course.Based on the data review, the parameters of the most efficient rTMS protocols’ designs in management of patients with neuropathic pain and comorbid depression have been revealed. Further research requires investigation of other promising indicators of rTMS efficacy use in neuropathic pain with comorbid depression, such as stimulation over multiple brain areas, the duration/timing of additional maintenance phase of treatment, and the figure‑of‑8 coil orientation options.
重复经颅磁刺激治疗神经性疼痛伴伴抑郁:有效治疗方案参数综述
神经性疼痛影响全球7%的普通人群,通常对镇痛治疗具有耐药性,并在57 - 65%的患者队列中合并抑郁状态。目前正在进行的治疗方法的研究,包括重复经颅磁刺激(rTMS)用于神经性疼痛和抑郁症,提供了有关治疗方案设计细节的新数据。我们的文献回顾的目的是评估那些治疗方案的参数,这些参数在神经性疼痛合并抑郁症的治疗中证明了显著的疗效。通过Scopus、Elsevier和PubMed数据库的搜索,我们发现了639篇同行评议文章。23项研究被纳入数据分析,而其他研究因其异质性研究设计而被排除在外。在整个数据分析中,我们评估了rTMS参数,如线圈类型、刺激区域类型、获得的诱发运动电位轨迹、刺激幅度、疗程持续时间、每天/每月疗程的频率/次数、疗程之间的持续时间、疗程的数量和频率、脉冲的数量和频率以及治疗效果。那些在M1脑区使用8型线圈进行重复经颅磁刺激的研究,每天10次或更多次,持续时间从7到40分钟,频率10 - 20赫兹,强度为静息运动阈值的80 - 90%,每次总脉冲数超过1500次,这些研究表明,在神经性疼痛合并抑郁症患者中,疼痛水平降低和抑郁评分降低的效果更大。进行额外的维持治疗阶段延长了疗程的治疗效果。基于数据回顾,揭示了最有效的rTMS方案设计参数,用于治疗神经性疼痛和共病性抑郁症患者。进一步的研究需要调查rTMS在神经性疼痛伴伴抑郁的疗效的其他有希望的指标,如对多个脑区的刺激,额外维持阶段治疗的持续时间/时间,以及8型线圈方向选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of neuromuscular diseases
Journal of neuromuscular diseases Medicine-Neurology (clinical)
CiteScore
5.10
自引率
6.10%
发文量
102
期刊介绍: The Journal of Neuromuscular Diseases aims to facilitate progress in understanding the molecular genetics/correlates, pathogenesis, pharmacology, diagnosis and treatment of acquired and genetic neuromuscular diseases (including muscular dystrophy, myasthenia gravis, spinal muscular atrophy, neuropathies, myopathies, myotonias and myositis). The journal publishes research reports, reviews, short communications, letters-to-the-editor, and will consider research that has negative findings. The journal is dedicated to providing an open forum for original research in basic science, translational and clinical research that will improve our fundamental understanding and lead to effective treatments of neuromuscular diseases.
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