Repetitive transcranial magnetic stimulation for neuropathic pain: a randomized multicentre sham-controlled trial

Attal, Nadine; Poindessous‐Jazat, Frédérique; Chauvigny, Edwige de; Quesada, Charles; Mhalla, Alaa; Ayache, Samar S.; Fermanian, Christophe; Nizard, Julien; Peyron, R.; Lefaucheur, Jean‐Pascal; Bouhassira, Didier

doi:10.1093/brain/awab208

Cited by 108 publications

(105 citation statements)

References 49 publications

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“…The results for chronic musculoskeletal pain are mirrored in studies on neuropathic pain suggesting that there might be considerable overlap in the brain processes between the two types of pain. This has been demonstrated, for example, very recently in a study by Attal et al (144), where it was shown that M1-rTMS, but not DLPFC-rTMS, induces significant effects on pain intensity changes compared to sham-rTMS.…”

Section: Concluding Remarks and Implications For Clinical Practicementioning

confidence: 75%

Brain Circuits Involved in the Development of Chronic Musculoskeletal Pain: Evidence From Non-invasive Brain Stimulation

et al. 2021

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It has been well-documented that the brain changes in states of chronic pain. Less is known about changes in the brain that predict the transition from acute to chronic pain. Evidence from neuroimaging studies suggests a shift from brain regions involved in nociceptive processing to corticostriatal brain regions that are instrumental in the processing of reward and emotional learning in the transition to the chronic state. In addition, dysfunction in descending pain modulatory circuits encompassing the periaqueductal gray and the rostral anterior cingulate cortex may also be a key risk factor for pain chronicity. Although longitudinal imaging studies have revealed potential predictors of pain chronicity, their causal role has not yet been determined. Here we review evidence from studies that involve non-invasive brain stimulation to elucidate to what extent they may help to elucidate the brain circuits involved in pain chronicity. Especially, we focus on studies using non-invasive brain stimulation techniques [e.g., transcranial magnetic stimulation (TMS), particularly its repetitive form (rTMS), transcranial alternating current stimulation (tACS), and transcranial direct current stimulation (tDCS)] in the context of musculoskeletal pain chronicity. We focus on the role of the motor cortex because of its known contribution to sensory components of pain via thalamic inhibition, and the role of the dorsolateral prefrontal cortex because of its role on cognitive and affective processing of pain. We will also discuss findings from studies using experimentally induced prolonged pain and studies implicating the DLPFC, which may shed light on the earliest transition phase to chronicity. We propose that combined brain stimulation and imaging studies might further advance mechanistic models of the chronicity process and involved brain circuits. Implications and challenges for translating the research on mechanistic models of the development of chronic pain to clinical practice will also be addressed.

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Section: Concluding Remarks and Implications For Clinical Practicementioning

confidence: 75%

Brain Circuits Involved in the Development of Chronic Musculoskeletal Pain: Evidence From Non-invasive Brain Stimulation

et al. 2021

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“…A recent large RCT reported that rTMS over the M1 hand area was effective in patients with peripheral neuropathic pain. Approximately 60% of the participants were patients with lower limb pain (Attal et al, 2021). Previous studies have reported the efficacy of rTMS for peripheral neuropathic pain (Lefaucheur et al, 2004;Attal et al, 2016;Pei et al, 2019), and rTMS may be effective for peripheral neuropathic pain regardless of the pain site.…”

Section: Discussionmentioning

confidence: 98%

“…Some other study groups restricted their inclusion criteria to predominantly upper limb pain patients with central post-stroke pain or complex regional pain syndrome, and they also showed that active TMS relieved pain more effectively compared with sham stimulation (Pleger et al, 2004;Picarelli et al, 2010;Ojala et al, 2021). In contrast, some studies have examined the effectiveness of rTMS in alleviating pain at different stimulation sites (Hirayama et al, 2006;Lefaucheur et al, 2006b;Jette et al, 2013;de Oliveira et al, 2014;Lindholm et al, 2015;Ayache et al, 2016;Nurmikko et al, 2016;André-Obadia et al, 2018;Galhardoni et al, 2019;Attal et al, 2021;Freigang et al, 2021;Ojala et al, 2021). We have reported that 5 Hz-rTMS to M1 relieved neuropathic pain, but that to the primary somatosensory cortex, premotor area, and supplementary motor area did not (Hirayama et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Difference in Analgesic Effects of Repetitive Transcranial Magnetic Stimulation According to the Site of Pain

Mori

Hosomi

Nishi

et al. 2021

Front. Hum. Neurosci.

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High-frequency repetitive transcranial magnetic stimulation (rTMS) of the primary motor cortex for neuropathic pain has been shown to be effective, according to systematic reviews and therapeutic guidelines. However, our large, rigorous, investigator-initiated, registration-directed clinical trial failed to show a positive primary outcome, and its subgroup analysis suggested that the analgesic effect varied according to the site of pain. The aim of this study was to investigate the differences in analgesic effects of rTMS for neuropathic pain between different pain sites by reviewing our previous clinical trials. We included three clinical trials in this mini meta-analysis: a multicenter randomized controlled trial at seven hospitals (N = 64), an investigator-initiated registration-directed clinical trial at three hospitals (N = 142), and an exploratory clinical trial examining different stimulation parameters (N = 22). The primary efficacy endpoint (change in pain scale) was extracted for each patient group with pain in the face, upper limb, or lower limb, and a meta-analysis of the efficacy of active rTMS against sham stimulation was performed. Standardized mean difference (SMD) with 95% confidence interval (CI) was calculated for pain change using a random-effects model. The analgesic effect of rTMS for upper limb pain was favorable (SMD = −0.45, 95% CI: −0.77 to −0.13). In contrast, rTMS did not produce significant pain relief on lower limb pain (SMD = 0.04, 95% CI: −0.33 to 0.41) or face (SMD = −0.24, 95% CI: −1.59 to 1.12). In conclusion, these findings suggest that rTMS provides analgesic effects in patients with neuropathic pain in the upper limb, but not in the lower limb or face, under the conditions of previous clinical trials. Owing to the main limitation of small number of studies included, many aspects should be clarified by further research and high-quality studies in these patients.

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“…Furthermore, the target was controlled using robotic assisted neuronavigation. Results showed that M1 stimulation was effective over 25 weeks with a total of 15 stimulations while DLPFC stimulation was not different from placebo stimulation [24].…”

Section: Neurostimulation Multimodal Approaches and Psychotherapymentioning

confidence: 91%

French guidelines for neuropathic pain: An update and commentary

2021

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Repetitive transcranial magnetic stimulation for neuropathic pain: a randomized multicentre sham-controlled trial

Cited by 108 publications

References 49 publications

Brain Circuits Involved in the Development of Chronic Musculoskeletal Pain: Evidence From Non-invasive Brain Stimulation

Brain Circuits Involved in the Development of Chronic Musculoskeletal Pain: Evidence From Non-invasive Brain Stimulation

Difference in Analgesic Effects of Repetitive Transcranial Magnetic Stimulation According to the Site of Pain

French guidelines for neuropathic pain: An update and commentary

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