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Zentrale und periphere Deafferenzierungsschmerzen

Therapie mit der repetitiven transkraniellen Magnetstimulation?

Central and peripheral deafferent pain

Therapy with repetitive transcranial magnetic stimulation

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Zusammenfassung

Hintergrund

In dieser randomisierten prospektiven plazebokontrollierten einfachen Blindstudie im „Cross-over-Design“ wurde die Effektivität einer wiederholten Anwendung einer hoch- bzw. niedrigfrequenten repetitiven transkraniellen Magnetstimulation (rTMS) mit der einer Plazebostimulation an 13 Patienten mit einem zentralen Schmerzsyndrom und 14 Patienten mit Phantomschmerzen verglichen.

Material und Methoden

In 3 Behandlungsblöcken à 5 Tagen wurden jeweils 500 Reize mit einer Frequenz von 1 Hz, 5 Hz und 2 Hz (Plazebostimulation) appliziert. Dabei wurde die basale Schmerzintensität im Verlauf vor, während und nach der Behandlung quantifiziert und mögliche konfundierende Faktoren berücksichtigt.

Ergebnisse

In allen Therapiegruppen zeigte sich 15 min nach der Stimulation eine Schmerzreduktion, aber kein signifikanter Unterschied zur Plazebostimulation. Langzeiteffekte der rTMS auf die Schmerzintensität oder die Stimmung konnten nicht nachgewiesen werden.

Schlussfolgerung

Derzeit kann aus unserer Sicht ein Einsatz der rTMS als Therapieverfahren bei den genannten Schmerzsyndromen nicht empfohlen werden.

Summary

Background

This study evaluates the effects of repeated sessions of low- and high-frequency repetitive transcranial magnetic stimulation (rTMS) over the primary motor cortex on central and phantom limb pain.

Methods

Twenty seven patients with central (n=13) and phantom limb (n=14) pain participated in a blind, randomised placebo-controlled study comparing the effect of 1-Hz and 5-Hz rTMS with sham stimulation. Each treatment block consisted of a 5-day baseline phase, a 5-day therapy phase, and an 18-day washout phase. In the therapy phase, 500 stimuli were applied in the particular frequency at about the same time on each day.

Results

A reduction in pain immediately after stimulation was observed in all therapy groups. This effect was similar for all treatment conditions, including sham stimulation. No significant long-term effects of rTMS on pain intensity or mood were observed.

Conclusion

At present, rTMS can not be recommended as a standard therapy for central and phantom limb pain.

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Authors and Affiliations

  1. Neurologische Klinik, Charité Centrum für Neurologie, Neurochirurgie und Psychiatrie, Charitéplatz 1, 10117, Berlin

    K. Irlbacher, J. Kuhnert, S. Röricht, B. U. Meyer &  S. A. Brandt

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  1. K. Irlbacher
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  2. J. Kuhnert
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  3. S. Röricht
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  4. B. U. Meyer
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  5. S. A. Brandt
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Correspondence to S. A. Brandt.

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Irlbacher, K., Kuhnert, J., Röricht, S. et al. Zentrale und periphere Deafferenzierungsschmerzen. Nervenarzt 77, 1196–1203 (2006). https://doi.org/10.1007/s00115-006-2148-1

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