Методики транскраниальной магнитной стимуляции в исследовании пациентов с хроническими болевыми синдромами

Актуальность проблемы хронической боли (ХБ) определяется сложностью клинической объективизации центральной сенситизации и нейропластических изменений. Существующие шкалы и опросники отражают лишь субъективное восприятие, а ряд инструментальных методов диагностики (функциональная магнитно-резонансная томография, электроэнцефалография, количественное сенсорное тестирование) обладают в отношении анализа ХБ характеристиками низкой специфичности и методологической сложности. Транскраниальная магнитная стимуляция (ТМС) – метод объективной и прямой оценки процессов возбуждения и торможения в коре головного мозга, потенциально лежащих в основе нейропластических изменений при ХБ. Цель работы – систематизировать данные о применении ТМС при различных хронических болевых синдромах. Проведен анализ исследований с использованием ТМС одиночными и парными стимулами для оценки кортикоспинальной возбудимости (MEP, rMT, SICI, ICF, CSP, SAI) на ресурсах PubMed, Scopus, Web of Science и Cochrane Library по ключевым запросам: «транскраниальная магнитная стимуляция и хроническая боль», «транскраниальная магнитная стимуляция парными стимулами и хроническая боль», «кортикоспинальная возбудимость и хроническая боль». Идентифицировано 1 247 записей. После удаления дубликатов и нерелевантных статей осталось 134 публикации. Полнотекстовый анализ позволил отобрать 29 работ с клиническими данными. Согласно результатам анализа, при нейропатической боли выявлено снижение внутрикоркового торможения (SICI) и межполушарная асимметрия возбудимости; при скелетно-мышечной боли – нарушение баланса торможения/возбуждения (соотношения SICI, ICF и CSP); при мигрени – сокращение коркового периода молчания (CSP); при фибромиалгии – ассоциация SICI с длительностью заболевания и тревогой, а ICF – с интенсивностью боли; при комплексном регионарном болевом синдроме – повышенная корковая возбудимость (увеличение rMT). Таким образом, параметры ТМС отражают ключевые нейропластические изменения при ХБ и обладают потенциалом в качестве объективных биомаркеров для персонализированной диагностики, терапии и мониторинга, однако требуют стандартизации протоколов и проспективной валидации для широкого внедрения в клиническую практику.

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