Longlasting antalgic effects of daily sessions of repetitive transcranial magnetic stimulation in central and peripheral neuropathic pain

Background and objective: A single session of repetitive transcranial magnetic stimulation (rTMS) over motor cortex had been reported to produce short term relief of some types of chronic pain. The present study investigated whether five consecutive days of rTMS would lead to longer lasting pain relief in unilateral chronic intractable neuropathic pain. Patients and methods: Forty eight patients with therapy resistant chronic unilateral pain syndromes (24 each with trigeminal neuralgia (TGN) and post-stroke pain syndrome (PSP)) participated. Fourteen from each group received 10 minutes real rTMS over the hand area of motor cortex (20 Hz, 10×10 s trains, intensity 80% of motor threshold) every day for five consecutive days. The remaining patients received sham stimulation. Pain was assessed using a visual analogue scale (VAS) and the Leeds assessment of neuropathic symptoms and signs (LANSS) scale, before, after the first, fourth, and fifth sessions, and two weeks after the last session. Results: No significant differences were found in basal pain ratings between patients receiving real- and sham-rTMS. However, a two factor ANOVA revealed a significant “± TMS” × “time” interaction indicating that real and sham rTMS had different effects on the VAS and LANSS scales. Post hoc testing showed that in both groups of patients, real-rTMS led to a greater improvement in scales than sham-rTMS, evident even two weeks after the end of the treatment. No patient experienced adverse effects. Conclusion: These results confirm that five daily sessions of rTMS over motor cortex can produce longlasting pain relief in patients with TGN or PSP.

[1]  H. Merskey,et al.  Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. , 1994, Pain. Supplement.

[2]  M Hallett,et al.  Rapid reversible modulation of human motor outputs after transient deafferentation of the forearm , 1992, Neurology.

[3]  T Hirayama,et al.  Chronic motor cortex stimulation in patients with thalamic pain. , 1993, Journal of neurosurgery.

[4]  U. Lindblom,et al.  Motor cortex stimulation as treatment of trigeminal neuropathic pain. , 1993, Acta neurochirurgica. Supplementum.

[5]  P. Rossini,et al.  Non-invasive electrical and magnetic stimulation of the brain, spinal cord and roots: basic principles and procedures for routine clinical application. Report of an IFCN committee. , 1994, Electroencephalography and clinical neurophysiology.

[6]  T. Yamamoto,et al.  Chronic motor cortex stimulation for central deafferentation pain: experience with bulbar pain secondary to Wallenberg syndrome. , 1994, Stereotactic and functional neurosurgery.

[7]  A. M. Harvey.  Classification of Chronic Pain—Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms , 1995 .

[8]  M Hallett,et al.  Mood improvement following daily left prefrontal repetitive transcranial magnetic stimulation in patients with depression: a placebo-controlled crossover trial. , 1997, The American journal of psychiatry.

[9]  R. Belmaker,et al.  Slow magnetic stimulation of prefrontal cortex in depression and schizophrenia , 1997, Progress in Neuro-Psychopharmacology and Biological Psychiatry.

[10]  Á. Pascual-Leone,et al.  Study and modulation of human cortical excitability with transcranial magnetic stimulation. , 1998, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[11]  Á. Pascual-Leone,et al.  Low-frequency repetitive transcranial magnetic stimulation of the motor cortex in writer’s cramp , 1999, Neurology.

[12]  Philippe Decq,et al.  Chronic motor cortex stimulation in the treatment of central and neuropathic pain. Correlations between clinical, electrophysiological and anatomical data , 1999, PAIN.

[13]  R. Peyron,et al.  Precentral Cortex Stimulation for the Treatment of Central Neuropathic Pain , 2000, Stereotactic and Functional Neurosurgery.

[14]  P Mertens,et al.  Electrical stimulation of motor cortex for pain control: a combined PET-scan and electrophysiological study , 1999, PAIN.

[15]  P Brugières,et al.  Motor cortex stimulation in the treatment of central and neuropathic pain. , 2000, Archives of medical research.

[16]  H. Emrich,et al.  High frequency repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex in schizophrenic patients , 2000, Neuroreport.

[17]  Tipu Z. Aziz,et al.  Motor cortex stimulation for chronic neuropathic pain: a preliminary study of 10 cases , 2000, Pain.

[18]  T Yoshimine,et al.  Motor cortex stimulation for central and peripheral deafferentation pain. Report of eight cases. , 2000, Journal of neurosurgery.

[19]  M. Bennett,et al.  The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs , 2001, Pain.

[20]  J. Lefaucheur,et al.  Pain relief induced by repetitive transcranial magnetic stimulation of precentral cortex , 2001, Neuroreport.

[21]  M. Karst,et al.  Repetitive Transcranial Magnetic Stimulation for the Treatment of Chronic Pain – A Pilot Study , 2002, European Neurology.

[22]  E. Khedr,et al.  Therapeutic effect of repetitive transcranial magnetic stimulation on motor function in Parkinson's disease patients , 2003, European journal of neurology.

[23]  Henrik Foltys,et al.  Repetitive transcranial magnetic stimulation of the parietal cortex transiently ameliorates phantom limb pain-like syndrome , 2003, Clinical Neurophysiology.

[24]  Ulf Lindblom,et al.  CLASSIFICATION OF CHRONIC PAIN , 2004 .

[25]  B. Pleger,et al.  Repetitive transcranial magnetic stimulation of the motor cortex attenuates pain perception in complex regional pain syndrome type I , 2004, Neuroscience Letters.

[26]  J. Lefaucheur,et al.  Neurogenic pain relief by repetitive transcranial magnetic cortical stimulation depends on the origin and the site of pain , 2004, Journal of Neurology, Neurosurgery & Psychiatry.

[27]  Heidi Johansen-Berg,et al.  Neuroimaging in Stroke Recovery: A Position Paper from the First International Workshop on Neuroimaging and Stroke Recovery , 2004, Cerebrovascular Diseases.

[28]  Jean-Pascal Lefaucheur,et al.  Neuropathic pain controlled for more than a year by monthly sessions of repetitive transcranial magnetic stimulation of the motor cortex , 2004, Neurophysiologie Clinique/Clinical Neurophysiology.

[29]  J. Rothwell,et al.  Comparison of descending volleys evoked by transcranial and epidural motor cortex stimulation in a conscious patient with bulbar pain , 2004, Clinical Neurophysiology.

[30]  P. Bath,et al.  Association between hormone replacement therapy and subsequent stroke: a meta-analysis , 2005, BMJ : British Medical Journal.