Repetitive Transcranial Magnetic Stimulation for the Treatment of Chronic Pain – A Pilot Study

Abstract

Invasive electrical stimulation of the motor cortex has been reported to be of therapeutic value in pain control. We were interested whether noninvasive repetitive transcranial magnetic stimulation (rTMS) of the primary motor cortex might also act beneficially. Twelve patients with therapy-resistant chronic pain syndromes (mean age 51.3 ± 12.6, 6 males) were included in a pilot study. They were treated with rTMS of the corresponding motor cortex area for 20 min (20 Hz, 20 × 2 s trains, intensity 80% of motor threshold) and sham stimulation (sequence-controlled cross-over design). Some of the patients (6/6) had an analgesic effect, but for the whole group, the difference between active and sham stimulation did not reach a level of significance (active rTMS: mean VAS reduction –4.0 ± 15.6%; sham rTMS: –2.3 ± 8.8%). Further studies using different rTMS stimulation parameters (duration and frequency of rTMS) or stimulation sites (e.g. anterior cingulate gyrus) are strongly encouraged.

Complementary and alternative medicine therapies for the anesthesiologist and pain practitioner: a narrative review

“…[65][66][67] Other energy therapies shown to have some benefit in both acute and chronic pain, e.g., repetitive transcranial magnetic stimulation, have also encountered difficulties in developing appropriate sham controls. [68][69][70][71][72] Physical modalities, such as chiropractic and massage, are equally difficult to blind, since the subjects under study can clearly discern whether they are truly receiving a massage or spinal manipulation. Furthermore, even a light touch can illicit changes in the limbic system, making it difficult to design a true control for physical modalities.…”

“…Furthermore, since animals likely do not understand the difference between true vs sham therapies, we can infer that they are not likely to exhibit a placebo response. [71][72][73][74][75][76][77][78][79][80][81] Some argue that acupuncture is no better than placebo since a few human studies showed no significant difference between sham needling and true acupuncture-ignoring the effects of needle insertion itself. 82 Nevertheless, blinding attempts with non-penetrating shams are possible in humans.…”

Repetitive transcranial magnetic stimulation in neurology and psychiatry

“…В трех исследо-ваниях (50 пациентов) при стимуляции зоны М1 была по-казана неэффективность высокочастотной рТМС [77,78,80]. Однако в этих работах использовалась круглая катуш-ка, которая не обеспечивает локального воздействия на стимулируемую зону [81]. В остальных исследованиях вы-сокочастотная рТМС была эффективна по сравнению с плацебо.…”

Pain in Chronic Pancreatitis: A Salutogenic Mechanism or a Maladaptive Brain Response?

“…TMS has the advantage of being noninvasive and safe if appropriate guidelines are followed [76] . Two recently published studies using rTMS applied to the motor cortex reported suppression of pain in patients with therapy-resistant chronic somatic pain syndromes [6,77] . In addition, Lefaucher et al [7] studied 60 patients suffering from intractable pain.…”