经颅磁刺激在中枢神经病理性疼痛中的应用研究进展

doi:10.20047/j.issn1673-7210.2023.07.11

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摘要中枢神经病理性疼痛（CNP）是由大脑或脊髓的病变引起的一种疼痛综合征，因疼痛程度严重且持续时间长，给患者带来极大的痛苦。经颅磁刺激（TMS）作为一种安全、无创的神经调控技术，其可通过激活下行疼痛控制通路，诱导神经可塑性，降低中枢敏化及调节神经炎症反应等机制发挥镇痛作用。目前，TMS已应用于中枢性卒中后疼痛、脊髓损伤后中枢性疼痛、多发性硬化后中枢性疼痛等的治疗，但由于刺激模式、治疗周期及在不同疾病中CNP发生机制的不同，所获得的镇痛效果存在差异。本文归纳总结了国内外TMS治疗CNP的相关文献，从TMS的作用原理、镇痛机制、临床应用及效果、安全性及未来发展前景等方面展开综述。

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	王豪楠韩永谦董燚菲陈志艳陈倩李咏梅

关键词 ：经颅磁刺激, 中枢神经病理性疼痛, 机制, 治疗, 综述

Abstract：Central neuropathic pain (CNP) is a pain syndrome caused by a lesion in the brain or spinal cord that causes great suffering to patients because of the severity and duration of the pain. As a safe and non-invasive neuromodulation technique, transcranial magnetic stimulation (TMS) can exert analgesic effects by activating downstream pain control pathways, inducing neuroplasticity, reducing central sensitization, and regulating neuroinflammatory responses, among other mechanisms. Currently, TMS has been applied to the treatment of central post-stroke pain, central post-spinal cord injury pain, and central post-multiple sclerosis pain, but the analgesic effects obtained vary due to differences in stimulation patterns, treatment periods, and mechanisms of CNP occurrence in different diseases. This paper summarizes the relevant literature on TMS for CNP at home and abroad, and reviews the principle of action, analgesic mechanism, clinical application and efficacy, safety, and future development prospects of TMS.

Key words： Transcranial magnetic stimulation Central neuropathic pain Mechanism Treatment Review

基金资助:云南省科技厅-昆医联合专项项目（20210 1AY070001-146）。

通讯作者: 李咏梅（1975.11-），女，博士，副教授，硕士生导师；研究方向：神经损伤康复、肌肉骨骼康复。

作者简介: 王豪楠（1997.10-），男，昆明医科大学第二附属医院2020级康复医学与理疗学专业在读硕士研究生；研究方向；神经康复、神经病理性疼痛的治疗。

引用本文:

王豪楠韩永谦董燚菲陈志艳陈倩李咏梅. 经颅磁刺激在中枢神经病理性疼痛中的应用研究进展[J]. 中国医药导报, 2023, 20(7): 54-58.
WANG Haonan HAN Yongqian DONG Yifei CHEN Zhiyan CHEN Qian LI Yongmei. Advances in the application of transcranial magnetic stimulation in central neuropathic pain. 中国医药导报, 2023, 20(7): 54-58.

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