The Clinical Research Of Using RTMS Combined With Sertraline To Treat Patients With Persist Somatoform Pain Disorder

Aim:To evaluate the efficacy and safety of rTMS combined with Sertraline to treat patients with Persist Somatoform Pain Disorder, and to seek the effective clinical treatment strategies of Persist Somatoform Pain Disorder; To investigate the correlation between the cognitive processing dysfunction and clinical symptoms, then explore regulation of cognitive processing function in pain.Method:The 80 cases patients with persistent somatoform pain disorder, who conform to the subject standard, would be divided into control group and treatment group, according to the randomized principle. The control group was treated with Sertraline of SSRI therapy, the treatment group was treated drug combined with rTMS. The two groups was evaluated by using VAS and HAMD24, KAMA as the primary outcome, event related cognitive potential P300 as neuroelectrophysiological outcome before treatment, after treatment for 3 weeks and 6 weeks, and to evaluate the adverse reaction with TESS, and To investigate the correlation between the cognitive processing dysfunction and clinical symptoms.Result:1. On the 3,6 weeks after the treatment, the score of HAMD, HAMA, VAS of two groups were all significant lower than the pre-treatment (P<0.05); and that of treatment group were significant lower than drug group (P<0.05). Pain, anxiety and depression symptoms be improved, the efficacy of treatment group was better than control group (P<0.05).2. The P300 of two groups before treatment exist significant difference with the normal group (P<0.05). The 3 weeks after treatment, the partial P300 index of control group and P300 each index was improvement than before treatment (P<0.05); The 6 weeks after treatment, the P300 index (excl target stimulation reaction) of control group and P300 each index were improvement than before treatment (P<0.05), Comparison among groups:3 weeks and 6weeks after treatment, the differences of P300 each index were statistically significant (P<0.05).3. The P300 latency and HAMD, HAMA and VAS scores were positively correlated, there was a significant difference between the two groups (P<0.05).4. The adverse reaction had statistical significance between two groups (P<0.05), so the treatment group adverse reaction was lower than the control group.Conclusion:1. Sertraline and rTMS combined with drug can be used in the treatment of PSPD, Sertraline may improve cognitive function of the brain and has analgesic effect, but more slowly. While the rTMS combined with drug can improve cognitive function, can reduce hyperalgesia and pain emotional response, enhance the effectiveness of Sertraline, in the short term. The two therapy may be synergistic effect, to improve the PSPD patients with depression, anxiety and pain, has synergistic effect, and compared with simple antidepressants that adverse reaction is low, can be used as an effective solution for the clinical treatment.2. The patients with PSPD have the phenomenon of brain auditory cognitive information processing slowing. P300 can be used as objective indexes in patients with PSPD.3. PSPD patients have cognitive impairment, impairment of cognitive function improvement after treatment so that pain symptoms improved, there is correlation between cognitive impairment and pain, which can be considered a hypothesis of cognitive processing functional regulate pain mechanism is establishment o...