Abstract：
BACKGROUND: Post-mastectomy pain Syndrome (PMPS), characterized by chronic neuropathic pain stemming from intercostobrachial nerve lesions, presents a formidable clinical challenge. With the incidence of breast cancer surging, effective interventions for PMPS are urgently needed. To address this, we conducted this double-blind, placebo-controlled, randomized clinical trial to study the efficacy of repetitive Transcranial Magnetic Stimulation (rTMS) therapy over the motor cortex on pain, quality of life and thermal sensitivity in PMPS patients.
METHODS: We delivered 15 rTMS sessions over three weeks in a cohort of 34 PMPS patients. These patients were allocated randomly to either rTMS therapy or sham therapy groups. Pain assessments, utilizing the Visual Analogue Scale (VAS) and Short Form McGill Pain Questionnaire (SF-MPQ), alongside quality-of-life evaluations through the Functional Assessment of Cancer Therapy-Breast (FACT-B), were recorded before and after the 15 sessions. Additionally, we assessed thermal sensitivity using Quantitative Sensory Testing (QST).
RESULTS: Our findings demonstrate the superior efficacy of rTMS therapy (over sham therapy) in reducing VAS and SF-MPQ scores (p < 0.0001), improving physical (p = 0.037), emotional (p = 0.033), and functional well-being (p = 0.020) components of quality of life, as quantified by FACT-B. Our investigation also unveiled marked enhancements in thermal sensitivity within the rTMS therapy group, with statistically significant improvements in cold detection threshold (p = 0.0001), warm detection threshold (p = 0.0033), cold pain threshold (p = 0.0078), and hot pain tolerance threshold (p = 0.0078).
CONCLUSIONS: The study underscores the profound positive impact of rTMS therapy on pain, quality of life, and thermal sensitivity in patients having PMPS, opening new avenues for pain management strategies.
METHODS: We delivered 15 rTMS sessions over three weeks in a cohort of 34 PMPS patients. These patients were allocated randomly to either rTMS therapy or sham therapy groups. Pain assessments, utilizing the Visual Analogue Scale (VAS) and Short Form McGill Pain Questionnaire (SF-MPQ), alongside quality-of-life evaluations through the Functional Assessment of Cancer Therapy-Breast (FACT-B), were recorded before and after the 15 sessions. Additionally, we assessed thermal sensitivity using Quantitative Sensory Testing (QST).
RESULTS: Our findings demonstrate the superior efficacy of rTMS therapy (over sham therapy) in reducing VAS and SF-MPQ scores (p < 0.0001), improving physical (p = 0.037), emotional (p = 0.033), and functional well-being (p = 0.020) components of quality of life, as quantified by FACT-B. Our investigation also unveiled marked enhancements in thermal sensitivity within the rTMS therapy group, with statistically significant improvements in cold detection threshold (p = 0.0001), warm detection threshold (p = 0.0033), cold pain threshold (p = 0.0078), and hot pain tolerance threshold (p = 0.0078).
CONCLUSIONS: The study underscores the profound positive impact of rTMS therapy on pain, quality of life, and thermal sensitivity in patients having PMPS, opening new avenues for pain management strategies.
摘要：
背景：乳房切除术后疼痛综合征（PMPS），以肋间臂神经损伤引起的慢性神经性疼痛为特征，提出了一个巨大的临床挑战。随着乳腺癌发病率的激增，迫切需要对PMPS进行有效干预。为了解决这个问题，我们进行了双盲，安慰剂对照,随机临床试验，研究重复经颅磁刺激（rTMS）疗法对运动皮层疼痛的疗效，PMPS患者的生活质量和热敏感性。
方法：我们在3周内对34名PMPS患者进行了15次rTMS治疗。这些患者被随机分配到rTMS治疗组或假治疗组。疼痛评估，利用视觉模拟量表(VAS)和简短形式的麦吉尔疼痛问卷(SF-MPQ)，通过乳腺癌治疗功能评估（FACT-B）进行生活质量评估，在15次会议之前和之后记录。此外,我们使用定量感觉测试（QST）评估热敏感性。
结果：我们的研究结果表明，rTMS治疗（优于假治疗）在降低VAS和SF-MPQ评分方面具有优异的疗效（p<0.0001），改善身体(p=0.037)，情绪（p=0.033），和功能幸福感(p=0.020)对生活质量的影响，由FACT-B量化。我们的调查还揭示了rTMS治疗组中热敏感性的显着增强，冷检测阈值有统计学显著改善(p=0.0001)，温检测阈值(p=0.0033)，冷痛阈（p=0.0078），和热痛耐受阈值（p=0.0078）。
结论：该研究强调了rTMS治疗对疼痛的深远积极影响，生活质量,和患有PMPS的患者的热敏感性，为疼痛管理策略开辟新的途径。
方法：我们在3周内对34名PMPS患者进行了15次rTMS治疗。这些患者被随机分配到rTMS治疗组或假治疗组。疼痛评估，利用视觉模拟量表(VAS)和简短形式的麦吉尔疼痛问卷(SF-MPQ)，通过乳腺癌治疗功能评估（FACT-B）进行生活质量评估，在15次会议之前和之后记录。此外,我们使用定量感觉测试（QST）评估热敏感性。
结果：我们的研究结果表明，rTMS治疗（优于假治疗）在降低VAS和SF-MPQ评分方面具有优异的疗效（p<0.0001），改善身体(p=0.037)，情绪（p=0.033），和功能幸福感(p=0.020)对生活质量的影响，由FACT-B量化。我们的调查还揭示了rTMS治疗组中热敏感性的显着增强，冷检测阈值有统计学显著改善(p=0.0001)，温检测阈值(p=0.0033)，冷痛阈（p=0.0078），和热痛耐受阈值（p=0.0078）。
结论：该研究强调了rTMS治疗对疼痛的深远积极影响，生活质量,和患有PMPS的患者的热敏感性，为疼痛管理策略开辟新的途径。
