Postoperative Left Prefrontal Repetitive Transcranial Magnetic Stimulation Reduces Patient-controlled Analgesia Use

Background:Several recent studies suggest that repetitive transcranial magnetic stimulation can temporarily reduce pain perception in neuropathic pain patients and in healthy adults using laboratory pain models. No studies have investigated the effects of prefrontal cortex stimulation using transcranial magnetic stimulation on postoperative pain. Methods:Twenty gastric bypass surgery patients were randomly assigned to receive 20 min of either active or sham left prefrontal repetitive transcranial magnetic stimulation immediately after surgery. Patient-controlled analgesia pump use was tracked, and patients also rated pain and mood twice per day using visual analog scales. Results:Groups were similar at baseline in terms of body mass index, age, mood ratings, pain ratings, surgery duration, time under anesthesia, and surgical anesthesia methods. Significant effects were observed for surgery type (open vs. laparoscopic) and condition (active vs. sham transcranial magnetic stimulation) on the cumulative amount of patient-delivered morphine during the 44 h after surgery. Active prefrontal repetitive transcranial magnetic stimulation was associated with a 40% reduction in total morphine use compared with sham during the 44 h after surgery. The effect seemed to be most prominent during the first 24 h after cortical stimulation delivery. No effects were observed for repetitive transcranial magnetic stimulation on mood ratings. Conclusions:A single session of postoperative prefrontal repetitive transcranial magnetic stimulation was associated with a reduction in patient-controlled analgesia pump use in gastric bypass surgery patients. This is important because the risks associated with postoperative morphine use are high, especially among obese patients who frequently have obstructive sleep apnea, right ventricular dysfunction, and pulmonary hypertension. These preliminary findings suggest a potential new noninvasive method for managing postoperative morphine use.

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

[2]  S H Lisanby,et al.  Transcranial Magnetic Stimulation Applications in Neuropsychiatry , 1999 .

[3]  Z. Nahas,et al.  Motor threshold in transcranial magnetic stimulation: a comparison of a neurophysiological method and a visualization of movement method. , 1998, The journal of ECT.

[4]  V. Amassian,et al.  Modelling magnetic coil excitation of human cerebral cortex with a peripheral nerve immersed in a brain-shaped volume conductor: the significance of fiber bending in excitation. , 1992, Electroencephalography and clinical neurophysiology.

[5]  J. Nguyen,et al.  Treatment of deafferentation pain by chronic stimulation of the motor cortex: report of a series of 20 cases. , 1997, Acta neurochirurgica. Supplement.

[6]  D. Cocito,et al.  Transcranial Magnetic Cortical Stimulation Relieves Central Pain , 2003, Stereotactic and Functional Neurosurgery.

[7]  J. Lefaucheur,et al.  Interventional neurophysiology for pain control: duration of pain relief following repetitive transcranial magnetic stimulation of the motor cortex , 2001, Neurophysiologie Clinique/Clinical Neurophysiology.

[8]  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.

[9]  K. R. Mills,et al.  Magnetic Stimulation of the Human Nervous System , 2000 .

[10]  F. Andrew Kozel,et al.  Mechanisms and the Current State of Transcranial Magnetic Stimulation , 2003, CNS Spectrums.

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

[12]  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.

[13]  S. Pridmore,et al.  Improvement in Chronic Pain with Transcranial Magnetic Stimulation , 2001, The Australian and New Zealand journal of psychiatry.

[14]  Anthony S. Bryk,et al.  Hierarchical Linear Models: Applications and Data Analysis Methods , 1992 .

[15]  R. Bosker.  Boekbespreking van "A.S. Bryk & S.W. Raudenbusch - Hierarchical linear models: Applications and data analysis methods" : Sage Publications, Newbury Parki, London/New Delhi 1992 , 1995 .

[16]  Alvaro Pascual-Leone,et al.  Repetitive transcranial magnetic stimulation for the treatment of depression. , 2005, Journal of psychiatry & neuroscience : JPN.

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

[18]  I. Greenberg,et al.  Behavioral and psychological factors in the assessment and treatment of obesity surgery patients. , 2005, Obesity research.

[19]  Robert D. Kerns,et al.  Explaining high rates of depression in chronic pain: A diathesis-stress framework. , 1996 .

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

[21]  J. Lefaucheur,et al.  The antalgic efficacy of chronic motor cortex stimulation is related to sensory changes in the painful zone. , 2002, Brain : a journal of neurology.

[22]  Ariel Graff-Guerrero,et al.  Repetitive transcranial magnetic stimulation of dorsolateral prefrontal cortex increases tolerance to human experimental pain. , 2005, Brain research. Cognitive brain research.

[23]  F. Mauguière,et al.  Parietal and cingulate processes in central pain. A combined positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) study of an unusual case , 2000, Pain.

[24]  Hiroshi Shibasaki,et al.  Transcranial magnetic stimulation (TMS) of the sensorimotor cortex and medial frontal cortex modifies human pain perception , 2003, Clinical Neurophysiology.

[25]  C. Epstein,et al.  Prediction of magnetically induced electric fields in biological tissue , 1991, IEEE Transactions on Biomedical Engineering.

[26]  S. Minoshima,et al.  Keeping pain out of mind: the role of the dorsolateral prefrontal cortex in pain modulation. , 2003, Brain : a journal of neurology.

[27]  A. Barker,et al.  NON-INVASIVE MAGNETIC STIMULATION OF HUMAN MOTOR CORTEX , 1985, The Lancet.

[28]  F. Awiszus.  TMS and threshold hunting. , 2003, Supplements to Clinical neurophysiology.

[29]  Saxby Pridmore,et al.  Transcranial Magnetic Stimulation and Chronic Pain: Current Status , 2005, Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists.

[30]  T. Ohnishi,et al.  Effects of 1-Hz repetitive transcranial magnetic stimulation on acute pain induced by capsaicin , 2004, Pain.

[31]  George Ms,et al.  Rapid-rate transcranial magnetic stimulation and ECT. , 1994, Convulsive therapy.

[32]  A. Gershon,et al.  Transcranial magnetic stimulation in the treatment of depression. , 2003, The American journal of psychiatry.

[33]  M Hallett,et al.  A theoretical calculation of the electric field induced in the cortex during magnetic stimulation. , 1991, Electroencephalography and clinical neurophysiology.

[34]  E. Wassermann.  Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5-7, 1996. , 1998, Electroencephalography and clinical neurophysiology.

[35]  K. Arita,et al.  Transcranial magnetic coil stimulation of motor cortex in patients with central pain. , 1995, Neurosurgery.

[36]  J. Rothwell,et al.  Longlasting antalgic effects of daily sessions of repetitive transcranial magnetic stimulation in central and peripheral neuropathic pain , 2005, Journal of Neurology, Neurosurgery & Psychiatry.

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

[38]  S. Raudenbush,et al.  Application of Hierarchical Linear Models to Assessing Change , 1987 .

[39]  M. George,et al.  Rapid-rate transcranial magnetic stimulation and ECT. , 1994, Convulsive therapy.

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

[41]  Jejo D. Koola,et al.  The Maximum-likelihood Strategy for Determining Transcranial Magnetic Stimulation Motor Threshold, Using Parameter Estimation by Sequential Testing Is Faster Than Conventional Methods With Similar Precision , 2004, The journal of ECT.

[42]  Saxby Pridmore,et al.  Changes to cold detection and pain thresholds following low and high frequency transcranial magnetic stimulation of the motor cortex , 2004, Neuroscience Letters.