Repetitive transcranial magnetic stimulation for chronic neuropathic pain in patients with bladder pain syndrome/interstitial cystitis

Cervigni, Mauro; Onesti, Emanuela; Ceccanti, Marco; Gori, María; Tartaglia, Gian Gaetano; Campagna, Giuseppe; Panico, Giovanni; Vacca, Lorenzo; Cambieri, Chiara; Libonati, Laura; Inghilleri, Maurizio

doi:10.1002/nau.23718

Cited by 42 publications

(51 citation statements)

References 83 publications

(171 reference statements)

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“…Cortical centers involved in salience evaluation and control of the LUT can be therapeutically targeted for symptom remission in patients with pelvic floor dysfunction . Recently, targeting some of these centers—the primary motor cortex in the area corresponding to the pelvic region and the prefrontal cortices—with multisession rTMS provided proof‐of‐concept evidence of promising therapeutic effects. Specific to UCPPS and of the rTMS protocols tested in the current study, a protocol compromised of multisessions of the low‐intensity HF‐rTMS applied to SMA should be studied for its possible effectiveness in treating symptoms of UCPPS, when taking into consideration the observed changes in muscle and brain activity in the current study and structural and functional changes in SMA observed in patients with UCPPS .…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, if exciting SMA reduces PFM tone and inhibiting SMA increases PFM tone, SMA is likely exerting an inhibitory influence on resting PFM tone. We expect that our preliminary study may provide hypotheses for further studies that seek to reduce PFM tone (eg, urologic pain) or increase PFM tone (eg, incontinence), including studies that seek to produce lasting effects on symptoms with repeated rTMS sessions …”

Section: Introductionmentioning

confidence: 99%

“…The motor cortex, including SMA, has been suggested as a target for noninvasive therapeutic neuromodulation, such as repetitive transcranial magnetic stimulation (rTMS). 8,[16][17][18] However, the effect of rTMS applied to the PFM representation in SMA has not been systematically tested. To begin to examine its effect, we applied two distinct rTMS protocols to SMA.…”

mentioning

confidence: 99%

“…We expect that our preliminary study may provide hypotheses for further studies that seek to reduce PFM tone (eg, urologic pain) or increase PFM tone (eg, incontinence), including studies that seek to produce lasting effects on symptoms with repeated rTMS sessions. [16][17][18][19][20] 2 | MATERIALS AND METHODS…”

mentioning

confidence: 99%

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Motor cortical neuromodulation of pelvic floor muscle tone: Potential implications for the treatment of urologic conditions

Yani

Fenske

Rodríguez

et al. 2019

Neurourology and Urodynamics

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Aims In the human brain, supplementary motor area (SMA) is involved in the control of pelvic floor muscles (PFMs). SMA dysfunction has been implicated in several disorders involving PFMs, including urinary incontinence and urologic pain. Here, we aimed to provide a proof‐of‐concept study to demonstrate the feasibility of modulating resting PFM activity (tone) as well as SMA activity with noninvasive stimulation of SMA. Methods We studied six patients (3 women + 3 men) with Urologic Chronic Pelvic Pain Syndrome. Repetitive transcranial magnetic stimulation (rTMS) was applied to SMA immediately after voiding. We tested two rTMS protocols: high‐frequency (HF‐rTMS) which is generally excitatory, and low‐frequency (LF‐rTMS) which is generally inhibitory. PFM activity was measured during rTMS using electromyography. Brain activity was measured immediately before and after rTMS using functional magnetic resonance imaging. Results The rTMS protocols had significantly different effects on resting activity in PFMs (P = 0.03): HF‐rTMS decreased and LF‐rTMS increased pelvic floor tone. SMA activity showed a clear trend ( P = 0.06) toward the expected differential changes: HF‐rTMS increased and LF‐rTMS decreased SMA activity. Conclusions We interpret the differential effects of rTMS at the brain and muscle level as novel support for an important inhibitory influence of SMA activity on pelvic floor tone after voiding. This preliminary study provides a framework for designing future studies to determine if neuromodulation of SMA could augment therapy for chronic urologic conditions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Motor cortical neuromodulation of pelvic floor muscle tone: Potential implications for the treatment of urologic conditions

Yani

Fenske

Rodríguez

et al. 2019

Neurourology and Urodynamics

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“…BPS is also frequently accompanied by urinary symptoms, including urgency, frequency, and nocturia (101,128). BPS is the cause of pain in more than 30% of women with chronic pelvic pain (CPP) (100). The mechanism of bladder pain and urinary problems is hypothesized to be associated with the misperceptions and improper integration of sensory information provided by bladder filling and central sensitization (101).…”

Section: Pelvic Painmentioning

confidence: 99%

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

Yang

Lee

2020

Front. Neurol.

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Recently, clinicians have been using repetitive transcranial magnetic stimulation (rTMS) for treating various pain conditions. This systematic narrative review aimed to examine the use and efficacy of rTMS for controlling various pain conditions. A PubMed search was conducted for articles that were published until June 7, 2019 and used rTMS for pain alleviation. The key search phrase for identifying potentially relevant articles was (repetitive transcranial magnetic stimulation AND pain). The following inclusion criteria were applied for article selection: (1) patients with pain, (2) rTMS was applied for pain management, and (3) follow-up evaluations were performed after rTMS stimulation to assess the reduction in pain. Review articles were excluded. Overall, 1,030 potentially relevant articles were identified. After reading the titles and abstracts and assessing eligibility based on the full-text articles, 106 publications were finally included in our analysis. Overall, our findings suggested that rTMS is beneficial for treating neuropathic pain of various origins, such as central pain, pain from peripheral nerve disorders, fibromyalgia, and migraine. Although data on the use of rTMS for orofacial pain, including trigeminal neuralgia, phantom pain, low back pain, myofascial pain syndrome, pelvic pain, and complex regional pain syndrome, were promising, there was insufficient evidence to determine the efficacy of rTMS for treating these conditions. Therefore, further studies are needed to validate the effects of rTMS on pain relief in these conditions. Overall, this review will help guide clinicians in making informed decisions regarding whether rTMS is an appropriate option for managing various pain conditions.

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Interventions for treating people with symptoms of bladder pain syndrome: a network meta-analysis

Imamura

Scott

Wallace

et al. 2020

Cochrane Database of Systematic Reviews

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Repetitive transcranial magnetic stimulation for chronic neuropathic pain in patients with bladder pain syndrome/interstitial cystitis

Abstract: The results of this study show that rTMS applied with an H-coil over the M1 in the area corresponding to the pelvic region in patients with BPS/IC appears to improve chronic pelvic pain (CPP) and associated urinary disorders.

Cited by 42 publications

References 83 publications

Motor cortical neuromodulation of pelvic floor muscle tone: Potential implications for the treatment of urologic conditions

Motor cortical neuromodulation of pelvic floor muscle tone: Potential implications for the treatment of urologic conditions

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

Interventions for treating people with symptoms of bladder pain syndrome: a network meta-analysis

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