Analgesic Effects of Directed Repetitive Transcranial Magnetic Stimulation in Acute Neuropathic Pain After Spinal Cord Injury

Abstract

Objectives Central neuropathic pain (CNP) often appears following spinal cord injury (SCI), but current treatments are not always successful. In this study, we evaluated the analgesic effects of repetitive transcranial magnetic stimulation (rTMS) applied over the hand area of the motor cortex in patients with acute CNP after SCI. Methods A total of 48 patients with complete or incomplete SCI and acute CNP participated in this study and were randomized to receive either rTMS (10 Hz, 1,500 stimuli; N = 24) or a sham intervention (N = 24) for three weeks. The numeric rating scale (NRS) and Short-Form McGill Pain Questionnaire-2 (Chinese Edition; SF-MPQ-2-CN) were analyzed to assess the degree of pain. Brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) were collected to explore expression influenced by rTMS. Motor-evoked potential (MEP) latency and maximal amplitude were measured to determine neurophysiological changes. The assessments were carried out at baseline (T0), three days (T1), one week (T2), two weeks (T3), and three weeks (T4) after onset of treatment. Results The analysis showed significant treatment–time interactions for the quality and intensity of pain, as measured by NRS (P < 0.001, η2 = 0.441) and SF-MPQ-2 (P < 0.001, η2 = 0.590). Compared with the sham group, the NRS and SF-MPQ2-CN scores were significantly lower on the third day (P < 0.001, Cohen’s d = 1.135; P = 0.006, Cohen’s d = 0.616) and after one week (P < 0.001, Cohen’s d = 0.846; P = 0.012, Cohen’s d = 0.557) of treatment. In addition, the serum levels of BDNF and NGF were significantly higher in the treated group after three weeks (P = 0.015, Cohen’s d = 0.539; P = 0.009, Cohen’s d = 0.580), and the MEP amplitude increased by 109.59% (P = 0.033, Cohen’s d = 0.464). Conclusions These findings indicate that 10 Hz rTMS over the hand area of the motor cortex could alleviate acute CNP in the early phase of SCI and could enhance MEP parameters and modulate BDNF and NGF secretion.

Efficacy of Repetitive Transcranial Magnetic Stimulation for Acute Central Post-stroke Pain: A Case Study

“…However, the analgesic effects of rTMS for acute and subacute pain have been less studied. Few studies have been performed on postsurgical pain ( 23 ), pain after spinal cord injury (SCI) ( 24 ), and experimental model pain. In addition, there are no data available on subacute CPSP ( 25 ).…”

Analgesic Effects of Navigated Repetitive Transcranial Magnetic Stimulation in Patients With Acute Central Poststroke Pain

“…Our previous randomized controlled trial (RCT), which was intended to investigate the analgesic effects of rTMS specifically on neuropathic pain in patients with SCI [ 18 ], revealed that 10 Hz rTMS produced transient analgesic effects from the third day to the first week. In the present study, using the same parameters as the previous trial, the pain intensity was lowest on the seventh day, and this analgesic effect lasted until the third week.…”

“…We used a neuronavigation system (visor2, ANT Neuro b.v., Enschede, Netherlands) to guide the magnetic stimulation, as described previously [ 18 ]. The system generated a three-dimensional reconstruction of the patient’s brain based on magnetic resonance imaging (MRI) data obtained before the first session.…”

“…We calculated Cohen’s d and η 2 as measures of effect sizes in this study. The interpretation of Cohen’s d and η 2 was described in our previous paper [ 18 ]. The percentage of change within each individual was calculated as follows: [(Post-rTMS − Pre-rTMS Score)/(Pre-rTMS Score)] × 100.…”

Successful treatment of the Meige's syndrome with navigated repetitive transcranial magnetic stimulation: A case report

“…The patient was enrolled and her first navigated rTMS treatment was carried out at the Department of Neurology, Xijing Hospital on July 27, 2020, with a CCY-1 stimulator (Yiruide Medical Equipment Company, China) using a figure 8 coil, following the safety guidelines and protocols for rTMS [3]. Navigation was performed using a neuronavigational system (visor2, ANT Neuro, Enschede, Netherlands) to guide the magnetic stimulation as previously described [4]. Briefly, before the first rTMS session, T1-weighted magnetic resonance imaging of the patient was integrated into the navigation system and a three-dimensional reconstruction of the patients' brain was generated accordingly.…”