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

Yang, Seoyon; Lee, Hee Jin

doi:10.3389/fneur.2020.00114

Cited by 88 publications

(87 citation statements)

References 131 publications

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“…The activity of mesolimbic system-related structures is reduced in patients with chronic pain, and studies have shown that chronic pain is effectively controlled by applying deep brain stimulation to one of the structures in the mesolimbic system [ 78 ]. Applying rTMS or transcranial direct current stimulation (tDCS) to the premotor cortex or primary motor cortex has been reported to be effective in reducing chronic pain [ 79 , 80 , 81 ]. This suggests that stimulation of the brain cortex by rTMS or tDCS may directly or indirectly improve activity of mesolimbic structures and normalize the altered connectivity between affected mesolimbic structures [ 79 , 80 , 81 ].…”

Section: Administration Of Dopaminergic Drugsmentioning

confidence: 99%

Association between Chronic Pain and Alterations in the Mesolimbic Dopaminergic System

et al. 2020

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Chronic pain (pain lasting for >3 months) decreases patient quality of life and even occupational abilities. It can be controlled by treatment, but often persists even after management. To properly control pain, its underlying mechanisms must be determined. This review outlines the role of the mesolimbic dopaminergic system in chronic pain. The mesolimbic system, a neural circuit, delivers dopamine from the ventral tegmental area to neural structures such as the nucleus accumbens, prefrontal cortex, anterior cingulate cortex, and amygdala. It controls executive, affective, and motivational functions. Chronic pain patients suffer from low dopamine production and delivery in this system. The volumes of structures constituting the mesolimbic system are known to be decreased in such patients. Studies on administration of dopaminergic drugs to control chronic pain, with a focus on increasing low dopamine levels in the mesolimbic system, show that it is effective in patients with Parkinson’s disease, restless legs syndrome, fibromyalgia, dry mouth syndrome, lumbar radicular pain, and chronic back pain. However, very few studies have confirmed these effects, and dopaminergic drugs are not commonly used to treat the various diseases causing chronic pain. Thus, further studies are required to determine the effectiveness of such treatment for chronic pain.

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Section: Administration Of Dopaminergic Drugsmentioning

confidence: 99%

Association between Chronic Pain and Alterations in the Mesolimbic Dopaminergic System

et al. 2020

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“…Repetitive transcranial magnetic stimulation (rTMS) induces electric currents in the brain using high-frequency stimuli that have a short duration through a strong magnetic field [ 6 ]. At least 1,000 impulses below 1 ms are applied.…”

Section: Reviewmentioning

confidence: 99%

“…At least 1,000 impulses below 1 ms are applied. It has been reported that rTMS is effective not only for neurogenic pain, but also for pain attributable to fibromyalgia syndrome, lumbar pain, and shoulder pain [ 6 ]. The primary motor cortex is the main target of stimulation.…”

Section: Reviewmentioning

confidence: 99%

“…The primary motor cortex is the main target of stimulation. Previous functional magnetic resonance imaging studies have demonstrated that rTMS on the primary motor cortex induces changes in the activity of cortical and subcortical structures related to pain processing and modulation [ 6 ]. Furthermore, the application of rTMS on the primary motor cortex may influence the endogenous opioid system.…”

Section: Reviewmentioning

confidence: 99%

“…Thus, chronic pain should be considered not as a mere symptom of disease, but as a disease in itself of the nervous system. To date, various methods have been applied to control chronic pain including exercise, physical therapy, medication, procedures, surgery, and psychotherapy [ 4 - 6 ]. In many cases, the symptoms of chronic pain are not fully resolved even with treatment, and a single mode of treatment often fails to control pain, necessitating the need for multiple treatment methods.…”

Section: Introductionmentioning

confidence: 99%

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Conservative Treatments Frequently Used for Chronic Pain Patients in Clinical Practice: A Literature Review

Lee¹

2020

Cureus

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Chronic pain is a common patient complaint in clinical practice. It results in the deterioration of patients’ quality of life and loss of productivity. Also, it often brings about psychiatric disorders such as depression and anxiety. Therefore, clinicians should manage chronic pain actively. Various conservative treatments, including pharmacological therapy, procedures, and exercise, are being used to control chronic pain. In this review article, I provide an overview of the commonly used treatments, including medication [anticonvulsants, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, antidepressants], procedures [injection of steroids and local anesthetics, pulsed radiofrequency (PRF), repetitive transcranial magnetic stimulation (rTMS), prolotherapy], and exercise. A brief overview of these treatments would allow clinicians to have an overall picture of the available tools for managing chronic pain in clinical practice at a glance.

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Systematic numerical assessment of occupational exposure to electromagnetic fields of transcranial magnetic stimulation

et al. 2022

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Purpose This study aims to perform a classification and rigorous numerical evaluation of the risks of occupational exposure in the health environment related to the administration of transcranial magnetic stimulation (TMS) treatment. The study investigates the numerically estimated induced electric field that occurs in the human tissues of an operator caused by exposure to the variable magnetic field produced by TMS during treatments. This could be a useful starting point for future risk assessment studies and safety indications in this context. Methods We performed a review of the actual positions assumed by clinicians during TMS treatments. Three different TMS coils (two circular and one figure‐of‐eight) were modeled and characterized numerically. Different orientations and positions of each coil with respect to the body of the operator were investigated to evaluate the induced electric (‐E) field in the body tissues. The collected data were processed to allow comparison with the safety standards for occupational exposure, as suggested by the International Commission on Non‐Ionizing Radiation Protection (ICNIRP) 2010 guidelines. Results Under the investigated conditions, exposure to TMS shows some criticalities for the operator performing the treatment. Depending on the model of the TMS coil and its relative position with respect to the operator's body, the numerically estimated E‐field could exceed the limits suggested by the ICNIRP 2010 guidelines. We established that the worst‐case scenario for the three coils occurs when they are placed in correspondence of the abdomen, with the handle oriented parallel to the body (II orientation). Working at a maximum TMS stimulator output (MSO), the induced E‐field is up to 7.32 V/m (circular coil) and up to 1.34 V/m (figure‐of‐eight coil). The induced E‐field can be modulated by the TMS percentage of MSO (%MSO) and by the distance between the source and the operator. At %MSO equal to or below 80%, the figure‐of‐eight coil was compliant with the ICNIRP limit (1.13 V/m). Conversely, the circular coil causes an induced E‐field above the limits, even when powered at a %MSO of 30%. Thus, in the investigated worst‐case conditions, an operator working with a circular coil should keep a distance from its edge to be compliant with the guidelines limit, which depends on the selected %MSO: 38 cm at 100%, 32 cm at 80%, 26.8 cm at 50%, and 19.8 cm at 30%. Furthermore, attention should be paid to the induced E‐field reached in the operator's hand as the operator typically holds the coil by hand. In fact in the hand, we estimated an induced E‐field up to 10 times higher than the limits. Conclusions Our numerical results indicate that coil positions, orientations, and distances with respect to the operator's body can determine the levels of induced E‐field that exceed the ICNIRP limits. The induced E‐field is also modulated by the choice of %MSO, which is related to the TMS application. Even under the best exposure conditions, attention should be paid to the exposure of the ha...

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

Cited by 88 publications

References 131 publications

Association between Chronic Pain and Alterations in the Mesolimbic Dopaminergic System

Association between Chronic Pain and Alterations in the Mesolimbic Dopaminergic System

Conservative Treatments Frequently Used for Chronic Pain Patients in Clinical Practice: A Literature Review

Systematic numerical assessment of occupational exposure to electromagnetic fields of transcranial magnetic stimulation

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