Repetitive transcranial magnetic stimulation in chronic pain: A meta-analysis

Abstract

Background:In this meta-analysis, we explore the role of repetitive transcranial magnetic stimulation (rTMS), a noninvasive neuromodulation technique in the treatment of chronic pain.Methods:Studies comparing rTMS and conventional treatment for chronic pain were searched. The comparison was made for decrease in the pain scores with and without (sham) the use of rTMS after a follow-up interval of 4–8 weeks. All reported pain scores were converted into a common scale ranging from “0” (no pain) to “10” (worst pain).Results:Nine trials with 183 patients in each of the groups were included in the analysis. The decrease in pain scores with rTMS was 1.12 (95% confidence interval [CI] being 1.46–0.78) (fixed effects, I2 = 0%, P < 0.001) and in sham-rTMS was 0.28 (95% CI being 0.49–0.07) (Fixed effects, I2 = 0, P = 0.01). The pooled mean drop in pain scores with rTMS therapy was higher by 0.79 (95% CI being 0.26–1.33) (fixed effects, I2 = 0, P < 0.01). The duration and frequency of rTMS were highly variable across trials. Publication bias was unlikely (Egger's test, X-intercept = 0.13, P = 0.75).Conclusions:Use of rTMS improves the efficacy of conventional medical treatment in chronic pain patients. This treatment is not associated with any direct adverse effects. However, the duration and frequency of rTMS therapy is presently highly variable and needs standardization.

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

“…44,45 This technique has emerged in recent years as an interesting and promising new treatment for pain. 29,[46][47][48][49] The efficacy of high-frequency rTMS over the M1 on chronic neuropathic pain that is resistant to drugs has already been demonstrated in previous studies conducted on a range of diseases. [50][51][52][53][54][55][56][57][58][59][60][61] In general, the clinical effect begins a few days after the end of the rTMS cycle, lasts less than a week after a single stimulation session, and 2-3 weeks after repeated cycles of rTMS.…”

“…In general, the clinical effect begins a few days after the end of the rTMS cycle, lasts less than a week after a single stimulation session, and 2‐3 weeks after repeated cycles of rTMS . This beneficial effect observed after repeated stimulation is a key factor that warrants being able to administer this treatment in clinical practice, even though it has yet to be characterized more thoroughly . Furthermore, rTMS may prove effective in the treatment of neuropathic pain with a central genesis by modulating, at the level of the cortex, the activity of related sub‐cortical circuits of the brain areas involved in pain processing (such as the thalamus, the anterior cingulate cortex and the orbital‐frontal region) that modulate the emotional component of pain, and by facilitating the inhibitory mechanisms of the descending pain pathway at the periaqueductal gray (PAG) level .…”

“…50,51,57,58 This beneficial effect observed after repeated stimulation is a key factor that warrants being able to administer this treatment in clinical practice, even though it has yet to be characterized more thoroughly. 27,29,49,[62][63][64] Furthermore, rTMS may prove effective in the treatment of neuropathic pain with a central genesis by modulating, at the level of the cortex, the activity of related sub-cortical circuits of the brain areas involved in pain processing (such as the thalamus, the anterior cingulate cortex and the orbital-frontal region) that modulate the emotional component of pain, and by facilitating the inhibitory mechanisms of the descending pain pathway at the periaqueductal gray (PAG) level. 65,66 Since the same systems, that is, the prefrontal cortex, limbic system, and PAG, are also involved in urinary bladder control, it may also be possible to use rTMS to treat urinary disorders.…”

Invasive and Noninvasive Brain Stimulation in Parkinson's Disease: Clinical Effects and Future Perspectives

“…For example, high‐frequency rTMS of SMA can be a suitable target for PD FOG . For other nonmotor symptoms, high‐frequency rTMS of M1 is a potential treatment for PD‐related chronic pain . Although one study did not show synergistic effects of sequential high‐frequency stimulation of M1 and DLPFC, other combination targets are still worth trying.…”

“…108 For other nonmotor symptoms, high-frequency rTMS of M1 is a potential treatment for PD-related chronic pain. 109 Although one study did not show synergistic effects of sequential high-frequency stimulation of M1 and DLPFC, 104 other combination targets are still worth trying. Because M1 cortical excitability studies showed increased facilitatory intracortical circuit (short interval intracortical facilitation), decreased SICI, and imaging studies showed decreased activities in motor associated area, such as the SMA, combined low-frequency rTMS of M1 with high-frequency rTMS of SMA or the premotor cortex could be a treatment option.…”