Clinical study of repetitive transcranial magnetic stimulation of the motor cortex for thalamic pain

Abstract

Thalamic pain is a severe pain that is often unresponsive to medical therapy. Repetitive transcranial magnetic stimulation (rTMS) entirely non-invasively modulates neuronal plasticity to produce therapeutic benefit. Since the rTMS stimulation parameters varied, it is difficult to determine which specific parameters are best for clinical use. The aim of this study was to evaluate the analgesic lasting effect of 10-Hz rTMS over the motor cortex (M1) for 10 consecutive days to treat thalamic pain.Patients were treated with daily 10-Hz rTMS sessions for 1000 pulses applied over the M1 for 10 consecutive days. Pain severity and mood were assessed at baseline, immediately after, 2 weeks, 4 weeks, 6 weeks, 8 weeks after rTMS. Pain severity was measured by the visual analogue scale (VAS) and the percentage of pain relief on VAS score was calculated between baseline and final examination. Mood was monitored using the Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD).Seven patients with thalamic pain were enrolled. VAS score was significantly decreased after rTMS. Mean VAS scores were 7 at baseline and decreased to 5.6 at 2 weeks after rTMS and then decreased to 3.9 at 8 weeks after rTMS. The analgesic effect of rTMS can last up to 8 weeks. The percentage of pain relief ranges from 25.0% to 66.7% at the 8th week. Four patients (3 moderate pain and 1 severe pain) achieved satisfactory relief (pain relief ≥40–69%).Although this was an open-label study without a control group, our findings show that 10 Hz rTMS over the M1 for 10 consecutive days can produce satisfactory or partial antalgic effect on patients with thalamic pain.

<p>Transcranial magnetic stimulation for the treatment of anxiety disorder</p>

“…Papers that cited symptoms of anxiety as comorbidity were grouped in Neurological Disorders (Table 3)40,45,47,51,54,55,59 and Psychiatric Disorders (Table 4). 6,21,39,41–44,46,48–50,52,53,56–58,60,61 We found that MDD is the psychiatric disorder with the highest occurrence appearing in seven papers while pain is the highest Neurological Disorders occurrence appearing in three papers.…”

Effect of Repetitive Transcranial Magnetic Stimulation on Pain Management: A Systematic Narrative Review

“…Similarly, in 2015, Kobayashi et al (42) reported that the application of 5-Hz rTMS over the M1 on the affected side of 18 patients with CPSP once a week effectively reduced pain for up to 8 weeks, and it remained effective in 61.1% of patients for up to 12 weeks. Most recently, Lin et al (43) reported that VAS scores were significantly decreased after 10-Hz rTMS sessions over the M1 for 10 days in seven patients with thalamic pain. The VAS score decreased from 7 to 5.6 at 2 weeks and then to 3.9 at 8 weeks after rTMS treatment.…”

Management of Central Post-Stroke Pain: Systematic Review and Meta-Analysis

“…Moreover, a recent review has suggested rTMS is a more advantageous treatment than pharmacological interventions due to a single-target mechanism that does not disrupt wider pathophysiological mechanisms[17]. The rTMS, MCS and DBS studies[11,26,41,52,56,58,67,71,84,99] included in this review primarily recruited participants who had medication refractory CPSP which illustrates the effectiveness of these interventions in reducing pain scores. Furthermore, a number of rTMS studies have shown effective neuropathic pain alleviation but were not included in this review as they did not report CPSP-specific data[6,68,69,95,100].…”