摘要： 目的 探讨高频重复经颅磁刺激对伴焦虑和（或）抑郁的神经病理性疼痛患者疼痛和情绪障碍的治疗作用。方法 纳入2019年6月至2021年10月在空军军医大学西京医院住院治疗的39例伴焦虑和（或）抑郁的神经病理性疼痛患者，随机分为常规治疗并假刺激组（对照组，19例）和常规治疗辅助高频重复经颅磁刺激组（rTMS组，20例）；于治疗前及治疗3d和1、2、3、4周时采用疼痛数字评价量表（NRS）评价疼痛状态、汉密尔顿焦虑量表14项（HAMA-14）评价焦虑状态、汉密尔顿抑郁量表17项（HAMD-17）评价抑郁状态。结果 rTMS组与对照组治疗前后NRS评分（F=23.573，P=0.000）、HAMD评分（F=15.426，P=0.000）差异有统计学意义，其中rTMS组治疗1、2、3和4周时NRS评分、HAMD评分均低于对照组（均P≤0.01）。同一处理组不同观察时间点NRS评分（F=317.751，P=0.000）、HAMA评分（F=81.510，P=0.000）和HAMD评分（F=32.773，P=0.000）差异亦有统计学意义，其中rTMS组治疗1、2、3和4周时NRS评分、HAMD评分均低于治疗前和治疗3d时（均P<0.01），治疗1、2和3周时HAMA评分均低于治疗前和治疗3d时（均P=0.000），治疗4周时HAMA评分低于治疗前（P=0.007）及治疗1周（P=0.014）和2周（P=0.001）时；对照组NRS评分仅治疗4周时低于治疗前（P=0.000），治疗1、2和3周时HAMA评分均低于治疗前（均P<0.05），治疗1周时HAMA评分低于治疗3d时（P=0.002）。Spearman秩相关分析显示，疼痛缓解程度与焦虑（r_s=0.442，P=0.048）和抑郁（r_s=0.705，P=0.001）情绪改善呈正相关。结论 高频重复经颅磁刺激治疗伴焦虑和（或）抑郁的神经病理性疼痛安全、有效，可在缓解疼痛症状的同时显著改善患者焦虑和抑郁情绪。

关键词: 神经痛, 经颅磁刺激, 情绪, 康复

Abstract: Objective To investigate the effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) on pain and emotion in patients with neuropathic pain (NP) combined with anxiety and/ or depression.Methods A total of 39 patients with NP combined with anxiety and/or depression from June 2019 to October 2021 were included and randomly divided into conventional treatment combined with sham stimulation group (control group, n = 19) and conventional treatment-assisted high-frequency rTMS (rTMS group, n = 20). The Numerical Rating Scale (NRS) was used to evaluate the pain state, Hamilton Anxiety Scale-14 (HAMA-14) was used to evaluate the anxiety state, and Hamilton Depression Scale-17 (HAMD-17) was used to evaluate depression state before treatment and at 3 days, 1 week, 2 weeks, 3 weeks and 4 weeks of treatment.Results The NRS score (F = 23.573, P=0.000) and HAMD score (F = 15.426, P=0.000) before and after treatment were significantly different between the 2 groups. The NRS score and HAMD score in rTMS group were lower than those in control group at 1, 2, 3 and 4 weeks of treatment (P≤0.01, for all). The differences in NRS score (F = 317.751, P=0.000), HAMA score (F = 81.510, P=0.000) and HAMD score (F = 32.773, P=0.000) at different observation times were also statistically significant in the same treatment group. In rTMS group, NRS score and HAMD score at 1, 2, 3 and 4 weeks of treatment were lower than those before treatment and 3 days of treatment (P<0.01, for all), and HAMA score at 1, 2 and 3 weeks of treatment were lower than those before treatment and 3 days of treatment (P=0.000, for all). HAMA score at 4 weeks of treatment was lower than that before treatment (P=0.007), at 1 week (P=0.014) and 2 weeks (P=0.001) of treatment. In control group, NRS score only at 4 weeks of treatment was lower than that before treatment (P=0.000), HAMA score at 1, 2 and 3 weeks of treatment was lower than those before treatment (P<0.05, for all), and HAMA score at 1 week of treatment was lower than that at 3 days of treatment (P=0.002). Spearman correlation analysis showed that the degree of pain relief before and after treatment was positively correlated with the ease of anxiety (r_s=0.442, P=0.048) and depression (r_s=0.705, P=0.001).Conclusions High-frequency rTMS is a safe and effective treatment for NP with anxiety and/ or depression. It can significantly ease anxiety and depression in patients while relieving pain.

Key words: Neuralgia, Transcranial magnetic stimulation, Mood, Rehabilitation