Highlights
- •20Hz-rTMS can be used safely in chronic neuropathic central pain.
- •An analgesic cumulative effect is taking place during the first 4-5 rTMS sessions.
- •Once installed, duration of the analgesic effect can be maintained over 2 weeks.
- •The analgesic effect is maintained after a year of treatment.
Abstract
Objectives
To confirm and extend previous results involving repetitive transcranial magnetic
stimulation (rTMS) aimed at alleviating refractory central neuropathic pain (CNP).
To evaluate pain relief in detail and to assess ongoing benefits after one year of
treatment.
Design
Prospective observational study.
Setting
University hospital. Outpatient settings.
Participants
Patients (N=80) with chronic central pain after brain or spinal cord injuries.
Interventions
High-frequency (20Hz) neuronavigated-rTMS sessions were applied on the primary motor
cortex using a figure-of-eight coil positioned by a robotized arm. Patients received
a minimum of 4 consecutive sessions, each separated by 3-4 weeks.
Main Outcome Measures
Percentage of pain relief (%R), duration of pain relief (DPR), numeric rating scale
(NRS), neuropathic pain symptom inventory (NPSI), and pain relief score (PRS).
Results
Seventy-one patients completed the study. On average, after the first 4 sessions,
%R was 28% and DPR was 11 days. Fifty-four patients (76%) were responders with a permissive
threshold of ≥10%R and 61% (43 patients) with a stringent threshold ≥30%R. After 12
months of treatment (15 sessions) we observed a cumulative effect on %R (48%), DPR
(20d), and on the prevailing NPSI sub-score (-28%). This effect reached significance
after 4 sessions and was further maintained over 12 months. Across participants, more
than 1000 rTMS sessions were delivered over 6 years without any adverse effect.
Conclusion
These results confirm that multiple rTMS sessions are both safe and have potential
as a treatment for CNP. An ongoing randomized controlled trial will allow teasing
out of this effect from placebo analgesia.
Graphical abstract
Graphical Abstract
Keywords
List of abbreviations:
CNP (central neuropathic pain), DPR (duration of pain relief), gNPSI (Neuropathic Pain Symptom Inventory Global Score), LEP (laser evoked potential), M1 (primary motor cortex), MRI (magnetic resonance imaging), MCS (motor cortex stimulation), MEP (motor evoked potential), NPSI (Neuropathic Pain Symptom Inventory), NPSIss (Neuropathic Pain Symptom Inventory Prevailing Sub-Score), NRS (numeric rating scale), PRS (pain relief score), %R (percentage of pain relief), rTMS (repetitive transcranial magnetic stimulation), SEP (somatosensory evoked potential)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 08, 2018
Footnotes
Supported by the Foundation APICIL (grant number: 1608047; 2015).
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
