Efficacy And Evaluation Of Repetitive Transcranial Magnetic Stimulation Combined With Pregabalin In The Treatment Of Neuropathic Pain

Objective:To evaluate the clinical efficacy of repetitive transcranial magnetic stimulation combined with pregabalin compared with single pregabalin in the treatment of neuropathic pain.Methods:The study participants were 19 patients who were admitted to the department of neurology in our hospital from September 2015 to January 2018 with neuropathic pain,including central neuropathic pain?such as post-stroke pain and spinal cord injury pain?and peripheral neuropathic pain?such as post-herpetic neuralgia and diabetic peripheral neuralgia?.They were divided into stimulation group?10 cases?,including post-herpetic neuralgia?4 cases?,diabetic peripheral neuralgia?1 case?,spinal cord injury pain?4 cases?,post-stroke pain?1 case?,and control group?9 cases?,including post-herpetic neuralgia?6 cases?,diabetic peripheral neuralgia?1 case?,spinal cord injury pain?1 case?,post-stroke pain?1 case?.The two groups was given pregabalin treatment,at the same time,the stimulation group was given repeated transcranial magnetic stimulation treatment.They used British Megstim repeated transcranial magnetic stimulation equipment and selected the primary motor area?M1 area?and lateral prefrontal cortex?DLPFC?as the treatment target for 4 weeks.The degree of pain relief and the improvement of sleeping quality during the treatment and also the short-and long-term therapeutic effects were evaluated by visual analogue scale?VAS?and Athens insomnia scale?AIS-5?before treatment,3 days of treatment,1 week of treatment,2 weeks of treatment,the end of treatment?control group 4 weeks?,2 weeks after treatment?control group 6 weeks?and 4 weeks after treatment?control group 8weeks?.Furthermore,motor evoked potential?MEP?and near infrared functional imaging?fNIRS?were detected before and after the treatment in the stimulation group to further evaluate the effects of repetitive transcranial magnetic stimulation on motor cortex excitability and cortical blood flow changes.Results:VAS score comparison:1.Vas score of stimulation group and control group decreased significantly before and after treatment?P₁=0.000??P₂=0.006?.2.At the end of treatment and 2 weeks after the treatment,the score of patients in the stimulation group decreased more significantly and there was significant statistical difference between two groups?P=0.007,P=0.008?;but it disappeared at 4 weeks after the treatment.?P=0.156?.3.At the time of 1 week,2 weeks and the end of treatment,the VAS score of the stimulation group decreased more than 3cm was significantly higher than that of the control group.The two groups had significantly statistical difference?P=0.01?.Comparison of Athens insomnia scale score:1.Before and after treatment,the sleep score of stimulation group and control group both decreased significantly?P₁=0.000??P₂=0.000?,There were significantly differences in sleep score between the two groups at the 3days,1week,2weeks,4weeks and 2 weeks after treatment?P=0.000??P=0.000??P=0.00??P=0.000??P=0.028?.There was no significantly statistical difference in sleep score between the two groups on 4 weeks after treament.2.There was a positive correlation between the pain relief and the improvement of sleeping quality?P=0.31,r=0.495?.During the whole experiment,only one patient in the stimulation group had headache.After adjusting the stimulation parameters,the headache disappeared,and the rest patients had no complaint in the process of treatment.Conclusion:1.Repetitive transcranial magnetic stimulation is a safe and effective method for the treatment of neuropathic pain,and the early effect of repetitive transcranial magnetic stimulation combined with pregabalin in the treatment of neuropathic pain is better than that of pregabalin alone.2.The advantage of repetitive transcranial magnetic stimulation combined with pregabalin compared with single pregabalin in the treatment of neuropathic pain is the former can last at least 2 weeks after the treatment of r TMS.3.Repetitive transcranial magnetic stimulation can improve insomnia of the patients with pain,and the effect appears before the improvement of pain.4.The degree of improvement of sleep quality is positively correlated with the degree of pain improvement.And they affect each other.