Abstract

Given pharmacological interventions’ limited efficacy and abundance of its adverse effects, the repetitive transcranial magnetic stimulation (rTMS) is considered a viable non-invasive option for managing chronic neuropathic pain of different origins with promising outcomes.

Purpose of Review

The provision of a systematic review of current literature on rTMS for managing chronic neuropathic pain of different origins, and assess its efficacy and outcomes, highlighting the need for standard protocols for utilizing rTMS.

Recent Findings

Variable stimulation modalities were trialed targeting the M1, DLPFC, and somatosensory cortices S1 and S2. The M1 yielded the best results in 11 of the studies. Frequency of stimulation was variable; however, optimal outcome was with higher frequencies ranging 10–20 Hz rather than low-frequency 1 Hz.

Summary

Repetitive TMS can produce significant relief from chronic neuropathic pain. The lack of standard methods for rTMS, stimulatory parameters, and target stimulation site precludes concluding the optimal modality for stimulation. The practical algorithm by Lefaucheur and Nguyen (Neurophysiol Clin. 49(4):301–7, 2019) can guide setting standardized algorithms for rTMS. Defining optimal stimulation sites, frequencies, and pulses to maximize patient’s pain relief and minimize required rTMS sessions requires further research.

中文翻译：

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重复经颅磁刺激治疗慢性神经性疼痛：系统评价

摘要

鉴于药物干预的有效性有限且其不良反应较多，重复经颅磁刺激 (rTMS) 被认为是一种可行的非侵入性选择，可用于管理不同来源的慢性神经性疼痛，并取得有希望的结果。

审查目的

提供有关 rTMS 管理不同来源慢性神经性疼痛的当前文献的系统评价，并评估其疗效和结果，强调需要使用 rTMS 的标准协议。

最近的发现

针对 M1、DLPFC 和体感皮层 S1 和 S2 试验了多种刺激方式。M1 在 11 项研究中取得了最好的结果。刺激频率是可变的；然而，最佳结果是使用 10-20 Hz 的较高频率而不是 1 Hz 的低频。

概括

重复 TMS 可以显着缓解慢性神经性疼痛。由于缺乏 rTMS、刺激参数和目标刺激部位的标准方法，因此无法得出最佳刺激方式。Lefaucheur 和 Nguyen 的实用算法（Neurophysiol Clin. 49(4):301–7, 2019）可以指导设置 rTMS 的标准化算法。定义最佳刺激部位、频率和脉冲以最大限度地缓解患者的疼痛并最大限度地减少所需的 rTMS 会话需要进一步研究。