The effect of rTMS in the management of pain associated with CRPS

Abstract

BackgroundTherapeutic management of pain in patients with complex regional pain syndrome (CRPS) is challenging. Repetitive transcranial magnetic stimulation (rTMS) has analgesic effects on several types of pain. However, its effect on CRPS has not been elucidated clearly. Therefore, we conducted a meta-analysis of the available clinical studies on rTMS treatment in patients with CRPS.Materials and methodsA comprehensive literature search was conducted using the PubMed, EMBASE, Cochrane Library, and SCOPUS databases. We included studies published up to February 09, 2020, that fulfilled our inclusion and exclusion criteria. Data regarding measurement of pain using the visual analog scale before and after rTMS treatment were collected to perform the meta-analysis. The meta-analysis was performed using Comprehensive Meta-analysis Version 2.ResultsA total of three studies (one randomized controlled trial and two prospective observational studies) involving 41 patients were included in this meta-analysis. No significant reduction in pain was observed immediately after one rTMS treatment session or immediately after the entire schedule of rTMS treatment sessions (5 or 10 sessions; P > 0.05). However, pain significantly reduced 1 week after the entire schedule of rTMS sessions (P < 0.001).ConclusionrTMS appears to have a functional analgesic effect in patients with CRPS.

Epidural unilateral stimulation with “adaptive stim” option in treatment of type II CRPS

“…CRPS involves vasomotor changes such as changes in color and temperature of the skin, edema, increased sensitivity to touch, and a limited range of movement. 1 CRPS type II is associated with a confirmed peripheral nerve injury, while CRPS type I is not associated with an apparent peripheral nerve injury. 1,2 There are four diagnostic tools for CRPS in adult populations (Veldman criteria, IASP criteria, Budapest Criteria, and Budapest Research Criteria).…”

“…1 CRPS type II is associated with a confirmed peripheral nerve injury, while CRPS type I is not associated with an apparent peripheral nerve injury. 1,2 There are four diagnostic tools for CRPS in adult populations (Veldman criteria, IASP criteria, Budapest Criteria, and Budapest Research Criteria). 3,4 The complex treatment of CRPS includes pharmacotherapy, nerve blocks, physical and psychological measures, and rTMS.…”

“…3,4 The complex treatment of CRPS includes pharmacotherapy, nerve blocks, physical and psychological measures, and rTMS. 1,5 Despite the ongoing therapy, sometimes, patients still have persistent, burning pain. It leads to the disability of patients and a decrease in the quality of life.…”

Epidural unilateral stimulation with “Adaptive Stim” option in treatment of type II CRPS

“…CRPS involves vasomotor changes such as changes in color and temperature of the skin, edema, increased sensitivity to touch, and a limited range of movement. 1 Depending on the presence of nerve damage, CRPS is divided into two types. CRPS type II is associated with a confirmed peripheral nerve injury, while CRPS type I is not associated with an apparent peripheral nerve injury.…”

“…CRPS type II is associated with a confirmed peripheral nerve injury, while CRPS type I is not associated with an apparent peripheral nerve injury. 1,2 There are four diagnostic tools for CRPS in adult populations. These include the Veldman criteria, IASP criteria, Budapest Criteria, and Budapest Research Criteria.…”