Transcranial Magnetic Stimulation in the Treatment of Chronic Widespread Pain

Abstract

Objective Our objective was to assess transcranial magnetic stimulation (TMS) in the treatment of chronic widespread pain (CWP). Methods Nineteen participants were randomized to two groups: one receiving active TMS (N=7) and another receiving sham stimulation (N=11) applied to the left dorsolateral prefrontal cortex. During sham stimulation, subjects heard a sound similar to the sound heard by those receiving the active treatment and received an active electrical stimulus to the scalp. The stimulation protocol consisted of 15 sessions completed within a 4-week period. Blind assessments were done at baseline and after each 5 sessions followed by blind assessments at 1 week, 1 month and 3 months after the last TMS sessions. The primary outcome variable was a pain measure, the Gracely Box Intensity Scale (BIRS). Results The percentage of subjects who guessed that they were receiving TMS was similar in the two groups. Both the TMS group and the sham group showed a statistically significant reduction in the BIRS scores from baseline during the acute phase of treatment and the follow-up phase. However, the TMS and sham groups did not differ in the change in the BIRS scores. Discussion Although some previous clinical studies and basic science studies of TMS in treating pain are promising, this study found no difference in the analgesic effect of TMS and sham stimulation. Future studies should utilize a sham condition that attempts to simulate the sound and sensation of the TMS stimulation. Stimulus location and other stimulus parameters should be explored in future studies.

Non-invasive brain stimulation techniques for chronic pain

“…In total 43 studies investigated rTMS (Ahmed 2011; André‐Obadia 2006; André‐Obadia 2008; André‐Obadia 2011; Avery 2013; Borckardt 2009; Boyer 2014, Carretero 2009; Dall'Agnol 2014; Defrin 2007; de Oliveira 2014; Fregni 2005; Fregni 2011; Hirayama 2006; Hosomi 2013; Irlbacher 2006; Jetté 2013, Kang 2009; Khedr 2005; Lee 2012; Lefaucheur 2001a; Lefaucheur 2001b; Lefaucheur 2004; Lefaucheur 2006; Lefaucheur 2008; Malavera 2013; Medeiros 2016; Mhalla 2011; Nardone 2017; Nurmikko 2016; Onesti 2013; Passard 2007; Picarelli 2010; Pleger 2004; Rollnik 2002; Saitoh 2007; Short 2011; Tekin 2014; Tzabazis 2013; Umezaki 2016; Yagci 2014; Yilmaz 2014). Eleven studies investigated CES (Capel 2003; Cork 2004; Gabis 2003; Gabis 2009; Katsnelson 2004; Lichtbroun 2001; Rintala 2010; Tan 2000; Tan 2006; Tan 2011; Taylor 2013), 36 studies investigated tDCS (Ahn 2017; Antal 2010; Ayache 2016; Bae 2014; Boggio 2009; Brietzke 2016; Chang 2017; …”

When pain gets stuck: the evolution of pain chronification and treatment resistance

“…The opportunities for integrated personalized medicine for pain are indeed exciting [29]. In an ideal world, optimal pain management would include: (1) understanding an individual’s genetic (genetic evaluations may only provide some insight to risk of chronic pain) and psychological history and status [171]; (2) aggressive perioperative processes including understanding the nociceptive load during surgery [30]; [154]; (3) therapies for any early onset pain; and (4) a greater understanding of the role of aggressive approaches to ‘reset’ brain function, as has been attempted in for some conditions with TMS [9], or even ECT [250]. These themes are presented in Figure 4 as two opposing processes – “ Drivers for Change ” (Figure 4a) that may induce chronification and potential biomarkers for these; and “ Treatment Approaches ” (Figure 4b) that recapitulate the model presented previously [106].…”

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

“…Conversely, three RCTs (53,55,59) opposed the beneficial effects of rTMS in patients with FM. A 2009 RCT conducted by Carretero (53) found that 1-Hz rTMS stimulation at the right DLPFC (14 patients) had no superior effect on pain reduction as compared with sham stimulation (12 patients) in 28 patients with FM and MDD.…”

“…A 2009 RCT conducted by Carretero (53) found that 1-Hz rTMS stimulation at the right DLPFC (14 patients) had no superior effect on pain reduction as compared with sham stimulation (12 patients) in 28 patients with FM and MDD. Two additional RCTs conducted in 2011 and 2015 (55,59) reported that there were no significant differences in pain reduction between patients who received rTMS and those who received sham stimulations. The treatment in these two RCTs consisted of 10-15 sessions of 10-Hz rTMS that targeted the left DLPFC.…”