高频重复经颅磁刺激对脑卒中后中枢性疼痛的疗效观察

doi:10.3877/cma.j.issn.2095-123X.2025.04.006

目的

分析10 Hz重复经颅磁刺激（rTMS）对脑卒中后中枢性疼痛（CPSP）的临床疗效。

方法

选取胜利油田中心医院神经康复科自2021年1月至2022年12月收治的46例CPSP患者为研究对象，按照随机数字表法分为对照组和试验组，每组23例。2组患者均给予基础康复治疗，对照组给予假刺激，试验组给予10 Hz rTMS，治疗4周；试验组1例患者、对照组3例患者因不能配合rTMS而中途退出试验。通过疼痛视觉模拟量表（VAS）、Barthel指数、汉密尔顿焦虑量表（HAMA）及汉密尔顿抑郁量表（HAMD）分别对患者治疗前后的疼痛感觉、日常生活活动能力、焦虑抑郁状况进行量化分析，并记录治疗过程中出现的不良事件。

结果

与治疗前比较，2组患者治疗后的VAS、HAMA、HAMD评分均降低，且试验组降低更明显，差异均有统计学意义（P<0.05）。与本组治疗前比较，2组患者的Barthel指数上升，差异有统计学意义（P<0.05），但试验组治疗前后的Barthel指数差值与对照组比较，差异无统计学意义（P>0.05）。本组患者中有2例出现头痛，予以减轻rTMS刺激强度后症状改善，其他患者未出现相关不良事件。

结论

在病灶侧M1区应用10 Hz rTMS可有效改善CPSP患者的疼痛及焦虑抑郁状态。

关键词: 脑卒中后中枢性疼痛, 重复经颅磁刺激, 康复治疗, 焦虑, 抑郁

Objective

To evaluate the therapeutic effectiveness of high-frequency (10 Hz) repetitive transcranial magnetic stimulation (rTMS) for managing central post-stroke pain (CPSP).

Methods

Forty-six patients with CPSP admitted to the Neurorehabilitation Department of Shengli Oilfield Central Hospital between January 2021 and December 2022 were enrolled and randomly assigned to a control group and an experimental group, with 23 patients in each group. Both groups of patients received basic rehabilitation treatment, with the control group receiving sham stimulation and the experimental group receiving 10 Hz rTMS for 4 weeks of treatment; One patient in the experimental group and three patients in the control group withdrew from the study due to inability to tolerate rTMS. The visual analogue scale for pain (VAS), Barthel index, Hamilton anxiety scale (HAMA), and Hamilton depression scale (HAMD) were employed to conduct a quantitative assessment of the patients' pain experience, daily living activity (ADL) capabilities, as well as their anxiety and depression states before and after treatment. Meanwhile, all adverse events that transpired throughout the treatment were carefully recorded.

Results

Compared with before treatment, the VAS, HAMA, and HAMD scores between two groups decreased after treatment, and the experimental group showed a more significant decrease, with statistically significant differences (P<0.05). Compared with before treatment, the Barthel index of both groups of patients increased significantly (P<0.05), but the difference in Barthel index between the experimental group and the control group before and after treatment was not statistically significant (P>0.05). Two patients had headache, and the symptoms improved after reducing the intensity of rTMS, while other patients did not have study related adverse events.

Conclusions

The application of 10 Hz rTMS in the M1 area on the lesion side can effectively improve the pain, anxiety and depression states of patients with CPSP.

Key words: Central post-stroke pain, Repetitive transcranial magnetic stimulation, Rehabilitation treatment, Anxiety, Depression

表1 2组脑卒中后中枢性疼痛患者的临床资料比较

Tab.1 Comparison of clinical data between two groups of central post-stroke pain patients

组别	例数	年龄（岁，mean±SD）	发病时间（d，mean±SD）	性别		发病类型		发病部位
组别	例数	年龄（岁，mean±SD）	发病时间（d，mean±SD）	男	女	脑出血	脑梗死	丘脑	脑干	基底节
对照组	20	52.65±4.84	24.95±2.40	14	6	10	12	8	7	5
试验组	22	53.09±5.53	26.64±4.36	13	8	10	10	6	8	8
t/χ²值		0.274	1.532	0.461		0.768		0.621
P值		0.800	0.936	0.938		0.808		0.939

表1 2组脑卒中后中枢性疼痛患者的临床资料比较

Tab.1 Comparison of clinical data between two groups of central post-stroke pain patients

组别	例数	年龄（岁，mean±SD）	发病时间（d，mean±SD）	性别		发病类型		发病部位
组别	例数	年龄（岁，mean±SD）	发病时间（d，mean±SD）	男	女	脑出血	脑梗死	丘脑	脑干	基底节
对照组	20	52.65±4.84	24.95±2.40	14	6	10	12	8	7	5
试验组	22	53.09±5.53	26.64±4.36	13	8	10	10	6	8	8
t/χ²值		0.274	1.532	0.461		0.768		0.621
P值		0.800	0.936	0.938		0.808		0.939

表2 2组CPSP患者治疗前后VAS评分比较（分，mean±SD）

Tab.2 Comparison of VAS scores between two groups of CPSP patients before and after treatment (score, mean±SD)

组别	例数	治疗前	治疗后	t值	P值
对照组	20	6.40±1.27	5.15±0.81	4.802	<0.001
试验组	22	6.59±1.18	4.05±0.84	7.627	<0.001
t值		0.191	1.105
P值		0.617	<0.001

表2 2组CPSP患者治疗前后VAS评分比较（分，mean±SD）

Tab.2 Comparison of VAS scores between two groups of CPSP patients before and after treatment (score, mean±SD)

组别	例数	治疗前	治疗后	t值	P值
对照组	20	6.40±1.27	5.15±0.81	4.802	<0.001
试验组	22	6.59±1.18	4.05±0.84	7.627	<0.001
t值		0.191	1.105
P值		0.617	<0.001

表3 2组CPSP患者治疗前后的Barthel指数比较（分，mean±SD）

Tab.3 Comparison of Barthel index between the two groups of CPSP patients before and after treatment (score, mean±SD)

组别	例数	治疗前	治疗后	t值	P值
对照组	20	38.00±8.94	55.75±7.48	9.013	<0.001
试验组	22	38.18±7.80	57.27±6.68	8.076	<0.001
t值		0.070	0.697
P值		0.944	0.490

表3 2组CPSP患者治疗前后的Barthel指数比较（分，mean±SD）

Tab.3 Comparison of Barthel index between the two groups of CPSP patients before and after treatment (score, mean±SD)

组别	例数	治疗前	治疗后	t值	P值
对照组	20	38.00±8.94	55.75±7.48	9.013	<0.001
试验组	22	38.18±7.80	57.27±6.68	8.076	<0.001
t值		0.070	0.697
P值		0.944	0.490

表4 2组CPSP患者治疗前后的HAMA和HAMD评分比较（分，mean±SD）

Tab.4 Comparison of HAMA and HAMD scores between the two groups of CPSP patients before and after treatment (score, mean±SD)

组别	例数	HAMA				HAMD
组别	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
对照组	20	13.00±2.25	10.25±1.62	5.597	<0.001	18.80±3.65	13.55±3.12	9.200	<0.001
试验组	22	13.23±2.14	8.55±1.68	7.485	<0.001	19.50±3.50	9.45±2.09	11.526	<0.001
t值		0.336	3.339			0.634	5.043
P值		0.739	0.002			0.530	<0.001

表4 2组CPSP患者治疗前后的HAMA和HAMD评分比较（分，mean±SD）

Tab.4 Comparison of HAMA and HAMD scores between the two groups of CPSP patients before and after treatment (score, mean±SD)

组别	例数	HAMA				HAMD
组别	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
对照组	20	13.00±2.25	10.25±1.62	5.597	<0.001	18.80±3.65	13.55±3.12	9.200	<0.001
试验组	22	13.23±2.14	8.55±1.68	7.485	<0.001	19.50±3.50	9.45±2.09	11.526	<0.001
t值		0.336	3.339			0.634	5.043
P值		0.739	0.002			0.530	<0.001

[1]	Zhou D, Zhang L, Mao L, et al. Biological mechanism on SIRT1/NLRP3/IL-18 signaling pathway of acupuncture for treatment of ischemic stroke with central poststroke pain[J]. Comput Intell Neurosci, 2022, 2022: 8958742. DOI: 10.1155/2022/8958742.
[2]	Choi HR, Aktas A, Bottros MM. Pharmacotherapy to manage central post-stroke pain[J]. CNS Drugs, 2021, 35(2): 151-160. DOI: 10.1007/s40263-021-00791-3.
[3]	Iglesias AH. Transcranial magnetic stimulation as treatment in multiple neurologic conditions[J]. Curr Neurol Neurosci Rep, 2020, 20(1): 1. DOI: 10.1007/s11910-020-1021-0.
[4]	Tomeh A, Yusof Khan AHK, Wan Sulaiman WA. Repetitive transcranial magnetic stimulation of the primary motor cortex in stroke survivors-more than motor rehabilitation: a mini-review[J]. Front Aging Neurosci, 2022, 14: 897837. DOI: 10.3389/fnagi.2022.897837.
[5]	黄志毅，赵娟. 重复经颅磁刺激联合分级运动想象训练对脑梗死后偏瘫患者运动功能及神经功能的影响[J]. 中华神经创伤外科电子杂志, 2023, 9(2): 102-107. DOI: 10.3877/cma.j.issn.2095-9141.2023.02.007.
[6]	武继敏，袁春雨，王鲁佳, 等. 重复经颅磁刺激治疗脑卒中后中枢性疼痛的研究进展[J]. 中华脑科疾病与康复杂志(电子版), 2024, 14(03): 182-186. DOI: 10.3877/cma.j.issn.2095-123X.2024.03.010.
[7]	Mohanan AT, Nithya S, Nomier Y, et al. Stroke-induced central pain: overview of the mechanisms, management, and emerging targets of central post-stroke pain[J]. Pharmaceuticals (Basel), 2023, 16(8): 1103. DOI: 10.3390/ph16081103.
[8]	Zhao CG, Sun W, Ju F, et al. Analgesic effects of navigated repetitive transcranial magnetic stimulation in patients with acute central poststroke pain[J]. Pain Ther, 2021, 10(2): 1101-1103. DOI: 10.1007/s40122-021-00270-2.
[9]	Paolucci S, Iosa M, Toni D, et al. Prevalence and time course of post-stroke pain: a multicenter prospective hospital-based study[J]. Pain Med, 2016, 17(5): 924-930. DOI: 10.1093/pm/pnv019.
[10]	You J, Li H, Xie D, et al. Acupuncture for chronic pain-related depression: a systematic review and meta-analysis[J]. Pain Res Manag, 2021, 2021: 6617075. DOI: 10.1155/2021/6617075.
[11]	Yang J, Dong Y, Liu J, et al. Primary ciliary protein kinase A activity in the prefrontal cortex modulates stress in mice[J]. Neuron, 2025, 113(8): 1276-1289.e5. DOI: 10.1016/j.neuron.2025.02.002.
[12]	Xiong LL, Chen J, Du RL, et al. Brain-derived neurotrophic factor and its related enzymes and receptors play important roles after hypoxic-ischemic brain damage[J]. Neural Regen Res, 2021, 16(8): 1453-1459. DOI: 10.4103/1673-5374.303033.

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Efficacy of high-frequency repetitive transcranial magnetic stimulation in treating central post-stroke pain

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Efficacy of high-frequency repetitive transcranial magnetic stimulation in treating central post-stroke pain