Effect of Single-Session Repetitive Transcranial Magnetic Stimulation Applied Over the Hand Versus Leg Motor Area on Pain After Spinal Cord Injury

Abstract

rTMS applied over the hand or leg motor cortex decreased neuropathic pain regardless of any change in cortical excitability, suggesting that the analgesic effect is not associated with local changes at the motor cortex level itself.

The CanPain SCI Clinical Practice Guidelines for Rehabilitation Management of Neuropathic Pain after Spinal Cord: Recommendations for treatment

“…Three RCTs in SCI-related NP compared the effect of transcranial magnetic stimulation with sham therapy. [54][55][56] Two of these trials found no significant difference in reduction in pain intensity. 54,55 The evidence quality of the third trial, which found a significant improvement in pain intensity after treatment, was downgraded because of wide confidence intervals.…”

“…54,55 The evidence quality of the third trial, which found a significant improvement in pain intensity after treatment, was downgraded because of wide confidence intervals. 56 2) Treatments with evidence of positive effect in populations other than SCI The SC evaluated several therapies with evidence of pain reduction in non-SCI populations, including cannabinoids, duloxetine and intrathecal clonidine.…”

rTMS of the prefrontal cortex has analgesic effects on neuropathic pain in subjects with spinal cord injury

“…2 To date, most studies have targeted the primary motor cortex (M1), mainly contralateral to the pain side, 3 whereas fewer studies reported analgesic effects after stimulation of other cortical areas, such as the prefrontal cortex (PFC)/dorsolateral PFC (DLPFC). [4][5][6][7][8] Also for managing neuropathic pain in subjects with spinal cord injury (SCI), M1 has been a popular target, [9][10][11][12][13][14] but it is unclear whether M1 is the only effective cortical target. To date, no studies have thoroughly investigated the effects of stimulation of other cortical targets (that is, PFC, parietal areas, supplementary motor area, primary or secondary somatosensory cortex) on neuropathic pain in SCI patients.…”

Physical rehabilitation to treat neuropathic pain

“…Ylmaz et al 34 have shown significant pain decrease in these patients, however statistical analysis used in this study has not compared interaction between group and time. Both hand and lower limb stimulation seem to have better effect as compared to simulated stimulation 35 , however this was not shown in an initial study 36 . An important factor might be the number of administered pulses, since studies with around 500 to 1000 pulses by session have not shown analgesic effect 36,37 .…”