Successful Treatment of Phantom Limb Pain by 1 Hz Repetitive Transcranial Magnetic Stimulation Over Affected Supplementary Motor Complex: A Case Report

Abstract

A 37-year-old man with a right transfemoral amputation suffered from severe phantom limb pain (PLP). After targeting the affected supplementary motor complex (SMC) or primary motor cortex (PMC) using a neuro-navigation system with 800 stimuli of 1 Hz repetitive transcranial magnetic stimulation (rTMS) at 85% of resting motor threshold, the 1 Hz rTMS over SMC dramatically reduced his visual analog scale (VAS) of PLP from 7 to 0. However, the 1 Hz rTMS over PMC failed to reduce pain. To our knowledge, this is the first case report of a successfully treated severe PLP with a low frequency rTMS over SMC in affected hemisphere.

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

“…In addition, 19 patients in the rTMS group (70.3%) reported significant pain reduction (> 30%) 15 days after treatment. Five case studies (88,(90)(91)(92)94) also reported that rTMS reduced pain in patients with PLP after amputation. High-frequency rTMS stimulation (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) Hz, mainly to the DLPFC) and low-frequency stimulation (1 Hz, targets including the supplementary motor complex, primary somatosensory area, and primary sensory cortex) were performed, and significant the patients reported significant improvements in PLP.…”

“…Our literature search revealed two RCTs (89,93) and five case studies (88,(90)(91)(92)94) that reported that the application of rTMS effectively reduced the pain associated with PLP. In 2011, Ahmed et al (89) applied 20-Hz rTMS to amputated patients with chronic PLP over the hand area of the M1 for 5 consecutive days.…”

Repetitive Transcranial Magnetic Stimulation for Phantom Limb Pain: Probably Effective but Understudied

“…They found a clinical improvement in perception of PLP (9). In another case report, Lee et al found that the 1 Hz rTMS could significantly reduce PLP in a patient with right transfemoral amputation, who suffered from severe PLP (10). In addition, a recent case series with two patients showed a clinical improvement in PLP after rTMS (11).…”

Phantom limb pain: peripheral neuromodulatory and neuroprosthetic approaches to treatment

“…studied the effect of rTMS at the ipsilateral motor cortex in 27 unilateral amputees with chronic PLP and found that high‐frequency rTMS applied for 5 consecutive days provided significant PLP relief for at least 2 months after the last session. In addition, there have been several clinical cases wherein rTMS was administered and patients showed a clinical improvement in PLP. rTMS is a promising future treatment for PLP because it is non‐invasive and reduces the intensity of PLP within a few sessions of therapy; however, long‐term efficacy is yet to be evaluated.…”