Long-term treatment of chronic orofacial,pudendal, and central neuropathic limb pain with repetitive transcranial magnetic stimulation of the motor cortex |
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| Affiliation: | 2. Carolina Center for Neurostimulation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599;3. Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599;4. Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599;5. Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599;6. Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599;11. Neuroscience Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599.;2. Pain Center, LIM-62, Department of Neurology, University of São Paulo, São Paulo, Brazil;3. Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry (INBioN), Department and Institute of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil;4. School of Medicine, University of City of São Paulo (UNICID), São Paulo, Brazil;5. Movement Disorders Clinic, Department of Neurology, Hospital das Clinicas of the University of São Paulo School of Medicine, São Paulo, Brazil;6. Pain Center, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil |
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| Abstract: | ObjectiveTo assess the long-term analgesic effects of high-frequency repetitive transcranial magnetic stimulation (rTMS) of the motor cortex in patients with chronic pain syndrome.MethodsThe study included 57 patients (orofacial pain, n = 26, pudendal neuralgia, n = 18, and neuropathic limb pain, n = 13) with an “induction phase” of 12 daily rTMS sessions for 3 weeks, followed by a “maintenance phase” of bi-monthly sessions for the next five months.ResultsAll pain measures significantly decreased from baseline to the end of the induction phase. Analgesic response, defined as pain intensity decrease ≥ 30% compared to baseline, was observed in 39 patients (68%), who could be differentiated from non-responders from the 7th rTMS session. At the end of the maintenance phase (D180), 27 patients (47%) were still responders. Anxio-depressive symptoms and quality of life also improved. The analgesic response at the end of the induction phase was associated with lower pain score at baseline, and the response at the end of the maintenance phase was associated with lower anxio-depressive score at baseline.ConclusionThe analgesic efficacy of motor cortex rTMS can be maintained in the long term in various chronic pain conditions. Patients with high pain level and severe anxio-depressive symptoms may have a less favorable profile to respond to the procedure.SignificanceThe overall impact of rTMS treatment on daily life requires a multidimensional evaluation that goes beyond the analgesic effect that can be achieved. |
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| Keywords: | Chronic pain Facial pain Long-term Neuropathic pain Predictive factor Pudendal neuralgia rTMS treatment |
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