The effect of a series of repetitive transcranial magnetic stimulations of the motor cortex on central pain after spinal cord injury

Arch Phys Med Rehabil. 2007 Dec;88(12):1574-80. doi: 10.1016/j.apmr.2007.07.025.

Abstract

Objective: To study the analgesic effect of repetitive transcranial magnetic stimulation (rTMS) of the motor cortex on central pain in patients with chronic spinal cord injury (SCI).

Design: Double-blind randomized controlled trial. Mean follow-up period was 4.5 weeks.

Setting: General hospital.

Participants: Twelve paraplegic patients due to thoracic SCI suffering chronic central pain (11 completed the study) who were randomly selected from a list of eligible patients.

Intervention: Real or sham 10 daily motor rTMS treatments (500 trains at 5 Hz for 10 s; total of 500 pulses at intensity of 115% of motor threshold) using figure-of-8 coil over the vertex.

Main outcome measures: Chronic pain intensity (visual analog scale [VAS], McGill Pain Questionnaire [MPQ]), pain threshold, and level of depression (Beck Depression Inventory).

Results: Both real and sham TMS induced a similar, significant reduction in VAS scores (P<.001) immediately after each of the 10 treatment sessions and in VAS and MPQ scores after the end of the treatment series. However, only real rTMS conferred a significant increase in heat-pain threshold (4 degrees C, P<.05) by the end of the series. Most important, the reduction in MPQ scores in the real rTMS group continued during the follow-up period. Depression scores were equally reduced in both groups but similar to pain relief, depression continued to improve at follow-up in the real rTMS group.

Conclusions: Whereas the pain alleviation induced by a single rTMS treatment is probably due to placebo, patients with SCI may benefit from a series of rTMS treatments.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Chronic Disease
  • Depression / etiology
  • Depression / therapy
  • Double-Blind Method
  • Female
  • Follow-Up Studies
  • Hot Temperature
  • Humans
  • Male
  • Middle Aged
  • Motor Cortex*
  • Pain / classification
  • Pain / etiology*
  • Pain / rehabilitation
  • Pain Measurement
  • Spinal Cord Injuries / complications*
  • Spinal Cord Injuries / rehabilitation
  • Transcranial Magnetic Stimulation / adverse effects
  • Transcranial Magnetic Stimulation / methods*