Mechanism of Transcranial Magnetic Stimulation Therapy for Neuropathic Pain
Neuropathic pain(NP)is a persistent and refractory chronic pain condition resulting from damage or disease of the somatosensory nervous system.Its complex pathogenesis,coupled with low clinical remission rate,significantly impairs the physical and mental well-being of the affected individuals.As a mature non-invasive neuromodulation technique,transcranial magnetic stimu-lation(TMS)can generate transient magnetic pulses penetrating through the skull,induce changes in cortical neuronal potentials,and affect the function and structure of the nervous system,which can not only alleviate NP-related symptoms,but also improve NP-related emotional disorders.However,there is no consensus on the neurobiological mechanism of TMS-induced analgesia.This study reviews the neurobiological mechanisms of TMS in alleviating NP from the aspects of regulation of synaptic plasticity,func-tional reorganization of neural network(inducing cortical-cortical functional connectivity and subcortical brain region functional connectivity),sensitivity of afferent nerve fibers,neurotransmitter levels and neuroimmunity based on the mechanism of TMS,in or-der to provide a basis for the treatment of NP by TMS.However,there are still some shortcomings,such as insufficient in-depth study of synaptic plasticity,the lack of further refinement in the research of the sensitivity of afferent nerve fibers,and the limitation of neuroimmune research.It is necessary to carry out multi-center and large sample studies,explore the mechanism of TMS regula-ting neural network by using new techniques such as cranial electroencephalogram,and promote the application of paired-pulse TMS in clinical research related to NP,so as to provide more reliable evidence for the treatment of NP with TMS.
neuropathic paintranscranial magnetic stimulationsynaptic plasticityneural networkneurobiological mecha-nism
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