Phantom Limb Pain: Low Frequency Repetitive Transcranial Magnetic Stimulation in Unaffected Hemisphere

Rollo, A. Di; Pallanti, Stefano

doi:10.1155/2011/130751

Cited by 24 publications

(21 citation statements)

References 25 publications

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“…The authors reported a maximum pain reduction of approximately 60% and 23.6%, during the rTMS treatment compared to baseline; however, the pain decrease was not maintained in the long term. Similarly, Di Rollo et al 10 in one patient with PLP of traumatic origin, applied 15 sessions of low frequency rTMS (thirty 20 second trains at 80% of RMT, 15 minutes) over the ipsilesional motor cortex, showing a pain reduction of 33.3% at the end of the third week of treatment and a slightly decrease (16.6%) at the follow-up visit (three weeks after the last session). In a recent clinical trial, Ahmed et al 1 evaluated the analgesic effect of rTMS for chronic PLP by assigning subjects to active (n=17) or sham (n=10) stimulation of the contralateral M1 for 5 consecutive days (200 pulses at 20 Hz, 10 seconds trains, at 80% of RMT).…”

Section: Discussionmentioning

confidence: 94%

“…1,10,46 These reports have evaluated either the effects of low frequency rTMS (< 1 Hz), which have demonstrated to decrease cortical network excitability, or high frequency (>1 Hz), which may induce an opposite effect. 2,40 In an initial case-report study, Topper et al 46 evaluated the effect of rTMS series on phantom pain-like syndrome in two patients with long-lasting brachial plexus avulsion, who underwent 10 and 1 Hz rTMS during 15 days, separated by 4 and 6 weeks respectively [at 110% of RMT, 12 minutes duration] over the contralateral posterior parietal cortex to the injured limb.…”

Section: Discussionmentioning

confidence: 99%

“…22,28,49 Some previous reports have also suggested analgesic effects of rTMS in subjects with PLP. 1,10 There have been only three trials testing rTMS in PLP – two of them were small pilot studies 10,46 and the other was a randomized clinical trial (RCT) with 27 subjects. 1 The RCT showed that 5 consecutive sessions of rTMS induce a significant analgesic effect as compared to sham rTMS, lasting up to two months in 39% of the subjects.…”

Section: Introductionmentioning

confidence: 99%

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Repetitive Transcranial Magnetic Stimulation for Phantom Limb Pain in Land Mine Victims: A Double-Blinded, Randomized, Sham-Controlled Trial

Malavera

Silva

Fregni

et al. 2016

The Journal of Pain

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We evaluated the effects of repetitive Transcranial Magnetic Stimulation (rTMS) in the treatment of phantom limb pain (PLP) in landmine victims. Fifty-four patients with PLP were enrolled in a randomized, double-blinded placebo-controlled parallel group, single center trial. The intervention consisted in real or sham rTMS of M1 contralateral to the amputated leg. RTMS was given in series of 20 trains of 6s of duration (54 s inter-train, intensity 90% of Motor Threshold) at a stimulation rate of 10 Hz (1200 pulses), 20 minutes per day, during 10 days. For the control group, a sham coil was used. The administration of active rTMS induced a significantly greater reduction in pain intensity (Visual Analogue Scale scores) fifteen days after treatment when compared to sham stimulation (−53.38±53.12% vs −22.93±57.16%; mean between-group difference=30.44%, 95%CI 0.30, 60.58; p=0.03). This effect was not significant 30 days after treatment. In addition, 70.3% (19) of subjects attained a clinically significant pain reduction (>30%) in the active group compared to 40.7% (11) in the sham group fifteen days after treatment (p=0.03). The administration of 10 Hz rTMS on the contralateral primary motor cortex for 2 weeks in traumatic amputees with PLP induces significant clinical improvement in pain. Trial registry www.clinicaltrials.gov: Code Number: NCT01872481 Perspective High frequency rTMS on the contralateral primary motor cortex of traumatic amputees induces a clinically significant pain reduction up to 15 days after treatment without any major secondary effect. These results indicate that rTMS is a safe and effective therapy in patients with phantom limb pain caused by landmine explosions.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Repetitive Transcranial Magnetic Stimulation for Phantom Limb Pain in Land Mine Victims: A Double-Blinded, Randomized, Sham-Controlled Trial

Malavera

Silva

Fregni

et al. 2016

The Journal of Pain

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“…Several studies have shown that a single session of rTMS can transiently relieve pain in some patients with chronic neuropathic pain,50–54 and a multiple application on several consecutive days can lead to prolongation of the effects 55,56. However, results from rTMS treatment specifically in patients with PLP are anecdotal, based on case-reports but not sham-controlled trials, and therefore not conclusive 55–57. Although the application of rTMS in PLP patients resulted in pain relief,55–57 short-term durability of the effects is a significant issue limiting clinical use of this treatment.…”

Section: Supportive Non-invasive Treatment Approachesmentioning

confidence: 99%

Current and future options for the management of phantom-limb pain

Knotková¹,

Cruciani²,

Tronnier³

et al. 2012

JPR

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Phantom-limb pain (PLP) belongs among difficult-to-treat chronic pain syndromes. Treatment options for PLP are to a large degree implicated by the level of understanding the mechanisms and nature of PLP. Research and clinical findings acknowledge the neuropathic nature of PLP and also suggest that both peripheral as well as central mechanisms, including neuroplastic changes in central nervous system, can contribute to PLP. Neuroimaging studies in PLP have indicated a relation between PLP and the neuroplastic changes. Further, it has been shown that the pathological neuroplastic changes could be reverted, and there is a parallel between an improvement (reversal) of the neuroplastic changes in PLP and pain relief. These findings facilitated explorations of novel neuromodulatory treatment strategies, adding to the variety of treatment approaches in PLP. Overall, available treatment options in PLP include pharmacological treatment, supportive non-pharmacological non-invasive strategies (eg, neuromodulation using transcranial magnetic stimulation, visual feedback therapy, or motor imagery; peripheral transcutaneous electrical nerve stimulation, physical therapy, reflexology, or various psychotherapeutic approaches), and invasive treatment strategies (eg, surgical destructive procedures, nerve blocks, or invasive neuromodulation using deep brain stimulation, motor cortex stimulation, or spinal cord stimulation). Venues of further development in PLP management include a technological and methodological improvement of existing treatment methods, an implementation of new techniques and products, and a development of new treatment approaches.

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“…15 The results of a case report by Di Rollo and Pallanti showed that low-frequency repetitive transcranial magnetic stimulation over the motor cortex in the unaffected hemisphere ameliorates PLP with long-lasting analgesic effects. 16 …”

mentioning

confidence: 99%

Use of Yamamoto New Scalp Acupuncture for Treatment of Chronic, Severe Phantom Leg Pain

Kotlyar

Brener

Lis

2012

Medical Acupuncture

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Background: Phantom limb pain (PLP) occurs in up to 85% of patients who have amputations and significantly worsens their quality of life. PLP is extremely difficult to treat, and common pain treatment is rarely effective. This case report describes the use of Yamamoto New Scalp Acupuncture (YNSA) to treat chronic severe PLP. Case: A 59-year-old man presented to an outpatient pain clinic with a chief complaint of chronic severe PLP after the left-femoral lower-third amputation that he had 21 years before. Intervention: YNSA was performed on the points representing the cranial nerves. Main Outcome Measures: PLP intensity, duration, and frequency were monitored to determine if the patient gained any pain relief from YNSA. Results: During the week after the thirteenth YNSA session, the patient reported a decrease in PLP intensity from 9 -1 before the treatment to *1 or no PLP at all. Following the sixteenth YNSA session, the patient reported a decrease in the average duration of PLP (0.5 -0.25 minutes) from * 13 -11 hours to 30 seconds per incidence, with an intensity of *1. After the twenty-fourth session, the patient reported a sustained reduction of *50% in the frequency of PLP episodes. Conclusions: This is the first case report on the effective use of YNSA for the treatment of chronic severe PLP.

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Phantom Limb Pain: Low Frequency Repetitive Transcranial Magnetic Stimulation in Unaffected Hemisphere

Cited by 24 publications

References 25 publications

Repetitive Transcranial Magnetic Stimulation for Phantom Limb Pain in Land Mine Victims: A Double-Blinded, Randomized, Sham-Controlled Trial

Repetitive Transcranial Magnetic Stimulation for Phantom Limb Pain in Land Mine Victims: A Double-Blinded, Randomized, Sham-Controlled Trial

Current and future options for the management of phantom-limb pain

Use of Yamamoto New Scalp Acupuncture for Treatment of Chronic, Severe Phantom Leg Pain

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