Ex) Article Title, Author, Keywords
Ex) Article Title, Author, Keywords
Clinical Pain 2019; 18(1): 1-7
Published online June 30, 2019
Copyright © Korean Association of Pain Medicine.
Yong Han, M.D.1, Chan Ho Lee, M.D.1, Kyung Wan Min, M.D., Ph.D.2, Kyung Ah Han, M.D., Ph.D.2, Hyo Seon Choi, M.D.1 and Youn Joo Kang, M.D., Ph.D.1
한 용1ㆍ이찬호1ㆍ민경완2ㆍ한경아2ㆍ최효선1ㆍ강윤주1
Objective: To investigate the cortical disinhibition in diabetic patients with neuropathic pain and without pain. In addition, we assessed the cortical disinhibition and pain relief after repetitive transcranial magnetic stimulation (rTMS). Method: We recruited diabetic patients with neuropathic pain (n = 15) and without pain (n = 15). We compared the TMS parameters such as motor evoked potential (MEP) amplitude, cortical silent period (CSP), intracortical inhibition (ICI %) and intracortical facilitation (ICF %) between two groups. Moreover, we evaluated the changes of pain and TMS parameters after five consecutive high frequency (10 Hz) rTMS sessions in diabetic patients with neuropathic pain. The neuropathic pain intensity (visual analog scale) and TMS parameters were assessed on pre-rTMS, post-rTMS 1day, and post-rTMS 5 day. Results: The comparison of the CSP, ICI % revealed significant differences between two groups (p<0.01). After rTMS sessions, the decrease in pain intensity across the three time points revealed a pattern of significant differences (p<0.01). The change of CSP and ICI % across the three test points revealed a pattern of significant differences (p<0.01). The ICI % revealed immediate increase after first rTMS application and significant increase after five rTMS application (p<0.01) in diabetic patients with neuropathic pain. The MEP amplitude and ICF % did not reveal any significant changes. Conclusion: Our findings demonstrate that cortical inhibition was decreased in diabetic patients with neuropathic pain compared with patients without pain. Furthermore, we also identified that five daily rTMS sessions restored the defective intracortical inhibition which related to improvement of neuropathic pain in diabetic patients.
KeywordsTranscranial magnetic stimulation, Cortical disinhibition, Diabetic neuropathy