Comparing the Impact of Multi-Session Left Dorsolateral Prefrontal and Primary Motor Cortex Neuronavigated Repetitive Transcranial Magnetic Stimulation (nrTMS) on Chronic Pain Patients

Freigang, Sascha; Lehner, Christian F.; Fresnoza, Shane; Ali, Kariem Mahdy; Hlavka, Elisabeth; Eitler, Annika; Szilagyi, Istvan S.; Bornemann‐Cimenti, Helmar; Deutschmann, Hannes; Reishofer, Gernot; Berlec, Anže; Kurschel-Lackner, Senta; Valentin, Antonio; Sutter, B.; Zaar, Karla; Mokry, Michael

doi:10.3390/brainsci11080961

Cited by 13 publications

(13 citation statements)

References 68 publications

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“…Perceived disability was also significantly reduced in the a-tDCS group compared to the s-tDCS group in the present study. Although no previous studies have examined the impact of left-DLPFC a-tDCS on perceived disability in CLBP, the present findings reflect those of Freigang et al [ 67 ], who found that tDCS over DLPFC improved perceived health-related quality of life—physical functioning in those with CLBP. Taken together, these findings suggest that a-tDCS over DLPFC may modulate the cognitive and emotional appraisal of pain, which may manifest as a reduction in the pain experience for those with CLBP.…”

Section: Discussionsupporting

confidence: 85%

“…While the mechanisms of action for tDCS and rTMS may differ, both techniques may lead to similar changes in cortical activity and, as such, have a similar effect on chronic pain [ 21 ]. Freigang et al [ 67 ] reported that, compared to motor cortex stimulation and sham, rTMS over left-DLPFC significantly reduced pain intensity in CLBP. In line with this, the present findings suggest that multi-session a-tDCS of left-DLPFC has an analgesic effect on CLBP.…”

Section: Discussionmentioning

confidence: 99%

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Anodal-TDCS over Left-DLPFC Modulates Motor Cortex Excitability in Chronic Lower Back Pain

et al. 2022

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Chronic pain is associated with abnormal cortical excitability and increased pain intensity. Research investigating the potential for transcranial direct current stimulation (tDCS) to modulate motor cortex excitability and reduce pain in individuals with chronic lower back pain (CLBP) yield mixed results. The present randomised, placebo-controlled study examined the impact of anodal-tDCS over left-dorsolateral prefrontal cortex (left-DLPFC) on motor cortex excitability and pain in those with CLBP. Nineteen participants with CLBP (Mage = 53.16 years, SDage = 14.80 years) received 20-min of sham or anodal tDCS, twice weekly, for 4 weeks. Short interval intracortical inhibition (SICI) and intracortical facilitation (ICF) were assessed using paired-pulse Transcranial Magnetic Stimulation prior to and immediately following the tDCS intervention. Linear Mixed Models revealed no significant effect of tDCS group or time, on SICI or ICF. The interactions between tDCS group and time on SICI and ICF only approached significance. Bayesian analyses revealed the anodal-tDCS group demonstrated higher ICF and SICI following the intervention compared to the sham-tDCS group. The anodal-tDCS group also demonstrated a reduction in pain intensity and self-reported disability compared to the sham-tDCS group. These findings provide preliminary support for anodal-tDCS over left-DLPFC to modulate cortical excitability and reduce pain in CLBP.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Anodal-TDCS over Left-DLPFC Modulates Motor Cortex Excitability in Chronic Lower Back Pain

et al. 2022

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“…12 It has shown that the left DLPFC area is likely to be a potential target for rTMS in treating various chronic pain diseases. [13][14][15] A clinical trial suggests that rTMS in the DLPFC area can effectively relieve NPP in patients with SCI, but the total sample size was only 12. 16 A study with larger sample size is needed to verify the conclusion that rTMS in the DLPFC area is effective in treating NPP.…”

Section: Open Accessmentioning

confidence: 99%

“…Simultaneously, DLPFC area also may affect pain through several brain function networks, such as the regulation of cognitive control networks, reward/fear pathway reaction etc 12. It has shown that the left DLPFC area is likely to be a potential target for rTMS in treating various chronic pain diseases 13–15. A clinical trial suggests that rTMS in the DLPFC area can effectively relieve NPP in patients with SCI, but the total sample size was only 12 16.…”

Section: Introductionmentioning

confidence: 99%

Effects of repeated transcranial magnetic stimulation in the dorsolateral prefrontal cortex versus motor cortex in patients with neuropathic pain after spinal cord injury: a study protocol

et al. 2022

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IntroductionNeuropathic pain is one of the common complications of spinal cord injuries (SCI), which will slow down the recovery process and result in lower quality of life. Previous studies have shown that repeated transcranial magnetic stimulation (rTMS) of the motor cortex (M1) can reduce the average pain and the most severe pain of neuropathic pain after SCI. The dorsolateral prefrontal cortex (DLPFC) area is a common target of rTMS. Recently, a few studies found that rTMS of DLPFC may relieve the neuropathic pain of SCI. Compared with the M1 area, the efficacy of rTMS treatment in the DLPFC area in improving neuropathic pain and pain-related symptoms in patients with SCI is still unclear. Therefore, our study aims to evaluate the non-inferiority of rTMS in the DLPFC vs M1 in patients with neuropathic pain after SCI, in order to provide more options for rTMS in treating neuropathic pain after SCI.Methods and analysisWe will recruit 50 subjects with neuropathic pain after SCI. They will be randomly assigned to the DLPFC- rTMS and M1-rTMS groups and be treated with rTMS for 4 weeks. Except for the different stimulation sites, the rTMS treatment programmes of the two groups are the same: 10 Hz, 1250 pulses, 115% intensity threshold, once a day, five times a week for 4 weeks. VAS, simplified McGill Pain Questionnaire, Spinal Cord Injury Pain Date Set, Pittsburgh Sleep Quality Index and Hamilton Anxiety Scale will be evaluated at baseline, second week of treatment, fourth week of treatment and 4 weeks after the end of treatment. And VAS change will be calculated.Ethics and disseminationThe Ethics Committee of the Affiliated Hospital of Southwest Medical University has approved this trial, which is numbered KY2020041. Written informed consent will be provided to all participants after verification of the eligibility criteria. The results of the study will be published in peer-reviewed publications.Trial registration numberChiCTR2000032362.

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“…Some other study groups restricted their inclusion criteria to predominantly upper limb pain patients with central post-stroke pain or complex regional pain syndrome, and they also showed that active TMS relieved pain more effectively compared with sham stimulation (Pleger et al, 2004;Picarelli et al, 2010;Ojala et al, 2021). In contrast, some studies have examined the effectiveness of rTMS in alleviating pain at different stimulation sites (Hirayama et al, 2006;Lefaucheur et al, 2006b;Jette et al, 2013;de Oliveira et al, 2014;Lindholm et al, 2015;Ayache et al, 2016;Nurmikko et al, 2016;André-Obadia et al, 2018;Galhardoni et al, 2019;Attal et al, 2021;Freigang et al, 2021;Ojala et al, 2021). We have reported that 5 Hz-rTMS to M1 relieved neuropathic pain, but that to the primary somatosensory cortex, premotor area, and supplementary motor area did not (Hirayama et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Difference in Analgesic Effects of Repetitive Transcranial Magnetic Stimulation According to the Site of Pain

Mori

Hosomi

Nishi

et al. 2021

Front. Hum. Neurosci.

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High-frequency repetitive transcranial magnetic stimulation (rTMS) of the primary motor cortex for neuropathic pain has been shown to be effective, according to systematic reviews and therapeutic guidelines. However, our large, rigorous, investigator-initiated, registration-directed clinical trial failed to show a positive primary outcome, and its subgroup analysis suggested that the analgesic effect varied according to the site of pain. The aim of this study was to investigate the differences in analgesic effects of rTMS for neuropathic pain between different pain sites by reviewing our previous clinical trials. We included three clinical trials in this mini meta-analysis: a multicenter randomized controlled trial at seven hospitals (N = 64), an investigator-initiated registration-directed clinical trial at three hospitals (N = 142), and an exploratory clinical trial examining different stimulation parameters (N = 22). The primary efficacy endpoint (change in pain scale) was extracted for each patient group with pain in the face, upper limb, or lower limb, and a meta-analysis of the efficacy of active rTMS against sham stimulation was performed. Standardized mean difference (SMD) with 95% confidence interval (CI) was calculated for pain change using a random-effects model. The analgesic effect of rTMS for upper limb pain was favorable (SMD = −0.45, 95% CI: −0.77 to −0.13). In contrast, rTMS did not produce significant pain relief on lower limb pain (SMD = 0.04, 95% CI: −0.33 to 0.41) or face (SMD = −0.24, 95% CI: −1.59 to 1.12). In conclusion, these findings suggest that rTMS provides analgesic effects in patients with neuropathic pain in the upper limb, but not in the lower limb or face, under the conditions of previous clinical trials. Owing to the main limitation of small number of studies included, many aspects should be clarified by further research and high-quality studies in these patients.

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Comparing the Impact of Multi-Session Left Dorsolateral Prefrontal and Primary Motor Cortex Neuronavigated Repetitive Transcranial Magnetic Stimulation (nrTMS) on Chronic Pain Patients

Cited by 13 publications

References 68 publications

Anodal-TDCS over Left-DLPFC Modulates Motor Cortex Excitability in Chronic Lower Back Pain

Anodal-TDCS over Left-DLPFC Modulates Motor Cortex Excitability in Chronic Lower Back Pain

Effects of repeated transcranial magnetic stimulation in the dorsolateral prefrontal cortex versus motor cortex in patients with neuropathic pain after spinal cord injury: a study protocol

Difference in Analgesic Effects of Repetitive Transcranial Magnetic Stimulation According to the Site of Pain

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