Role of the primary motor cortex in the maintenance and treatment of pain in fibromyalgia

Saavedra, Laura Castillo; Mendonça, Mariana E.; Fregni, Felipe

doi:10.1016/j.mehy.2014.06.007

Cited by 71 publications

(52 citation statements)

References 28 publications

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“…Therefore, cortical deafferentation and lack of inhibitory activity may play a role in phantom pain that still needs to be elucidated. This notion is also supported by studies showing decreased intracortical inhibition in neuropathic pain and other chronic pain syndromes (Castillo Saavedra et al, 2014;Tarrago Mda et al, 2016).…”

Section: Introductionmentioning

confidence: 54%

Motor Cortex Reorganization in Limb Amputation: A Systematic Review of TMS Motor Mapping Studies

et al. 2020

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Purpose: The purpose of this systematic review is to evaluate motor cortex reorganization in amputees as indexed by transcranial magnetic stimulation (TMS) cortical mapping and its relationship with phantom limb pain (PLP).Methods: Pubmed database were systematically searched. Three independent researchers screened the relevant articles, and the data of motor output maps, including the number of effective stimulation sites, center of gravity (CoG) shift, and their clinical correlations were extracted. We calculated a pooled CoG shift for motor cortex TMS mapping.Results: The search yielded 468 articles, 11 were included. Three studies performed correlation between the cortical changes and PLP intensity, and only one study compared cortical mapping changes between amputees with pain and without pain. Results showed (i) enlarged excitable area and a shift of CoG of neighboring areas toward the deafferented limb area; (ii) no correlation between motor cortex reorganization and level of pain and (iii) greater cortical reorganization in patients with PLP compared to amputation without pain.Conclusion: Our review supports the evidence for cortical reorganization in the affected hemisphere following an amputation. The motor cortex reorganization could be a potential clinical target for prevention and treatment response of PLP.

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Section: Introductionmentioning

confidence: 54%

Motor Cortex Reorganization in Limb Amputation: A Systematic Review of TMS Motor Mapping Studies

et al. 2020

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“…The authors explained that lack of effects is likely due to refractoriness of pain and duration of disease since most of the patients enrolled had injury durations of 10 or more years. In addition, the limited number of [19][20][21][22][23][24][25][26] sessions and small sample size, may not have been sufficient to observe significant effects at follow-up. The second study, on low back pain, even though the sample size was large (n = 135), did not show significant differences between sham and active tDCS [58].…”

Section: Delayed Tdcs Effects On Pain Reductionmentioning

confidence: 99%

“…We chose M1 as the target given its effects as central pain modulation [21]. Several studies have shown that M1 stimulation leads to local and distant effects that result in pain reduction.…”

Section: Introductionmentioning

confidence: 99%

Delayed pain decrease following M1 tDCS in spinal cord injury: A randomized controlled clinical trial

Thibaut

Carvalho

Morse

et al. 2017

Neuroscience Letters

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“…9 Several studies 5,14,24,30,37,42 have shown that stimulation of this brain area can induce significant analgesic effects in FM, mainly through modification in sensory processing of pain by thalamic inhibitory networks. Nonetheless, the results are inconsistent and some studies have achieved only marginal benefits.…”

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confidence: 99%

Clinically Effective Treatment of Fibromyalgia Pain With High-Definition Transcranial Direct Current Stimulation: Phase II Open-Label Dose Optimization

Castillo-Saavedra

Gebodh

Bikson

et al. 2016

The Journal of Pain

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114

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Despite promising preliminary results in treating fibromyalgia (FM) pain, no neuromodulation technique has been adopted in clinical practice because of limited efficacy, low response rate, or poor tolerability. This phase II open-label trial aims to define a methodology for a clinically effective treatment of pain in FM by establishing treatment protocols and screening procedures to maximize efficacy and response rate. High-definition transcranial direct current stimulation (HD-tDCS) provides targeted subthreshold brain stimulation, combining tolerability with specificity. We aimed to establish the number of HD-tDCS sessions required to achieve a 50% FM pain reduction, and to characterize the biometrics of the response, including brain network activation pain scores of contact heat-evoked potentials. We report a clinically significant benefit of a 50% pain reduction in half (n = 7) of the patients (N = 14), with responders and nonresponders alike benefiting from a cumulative effect of treatment, reflected in significant pain reduction (P = .035) as well as improved quality of life (P = .001) over time. We also report an aggregate 6-week response rate of 50% of patients and estimate 15 as the median number of HD-tDCS sessions to reach clinically meaningful outcomes. The methodology for a pivotal FM neuromodulation clinical trial with individualized treatment is thus supported.

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Role of the primary motor cortex in the maintenance and treatment of pain in fibromyalgia

Cited by 71 publications

References 28 publications

Motor Cortex Reorganization in Limb Amputation: A Systematic Review of TMS Motor Mapping Studies

Motor Cortex Reorganization in Limb Amputation: A Systematic Review of TMS Motor Mapping Studies

Delayed pain decrease following M1 tDCS in spinal cord injury: A randomized controlled clinical trial

Clinically Effective Treatment of Fibromyalgia Pain With High-Definition Transcranial Direct Current Stimulation: Phase II Open-Label Dose Optimization

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