The effect of rTMS in the management of pain associated with CRPS

Min Cheol Chang; Sang Gyu Kwak; Donghwi Park

doi:10.1515/tnsci-2020-0120

The effect of rTMS in the management of pain associated with CRPS

Transl Neurosci. 2020 Sep 28;11(1):363-370. doi: 10.1515/tnsci-2020-0120. eCollection 2020.

Authors

Min Cheol Chang¹, Sang Gyu Kwak², Donghwi Park³

Affiliations

¹ Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea.
² Department of Medical Statistics, College of Medicine, Catholic University of Daegu, Daegu, Republic of Korea.
³ Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojinsunhwando-ro, Dong-gu, 44033, Ulsan, Republic of Korea.

Abstract

Background: Therapeutic management of pain in patients with complex regional pain syndrome (CRPS) is challenging. Repetitive transcranial magnetic stimulation (rTMS) has analgesic effects on several types of pain. However, its effect on CRPS has not been elucidated clearly. Therefore, we conducted a meta-analysis of the available clinical studies on rTMS treatment in patients with CRPS.

Materials and methods: A comprehensive literature search was conducted using the PubMed, EMBASE, Cochrane Library, and SCOPUS databases. We included studies published up to February 09, 2020, that fulfilled our inclusion and exclusion criteria. Data regarding measurement of pain using the visual analog scale before and after rTMS treatment were collected to perform the meta-analysis. The meta-analysis was performed using Comprehensive Meta-analysis Version 2.

Results: A total of three studies (one randomized controlled trial and two prospective observational studies) involving 41 patients were included in this meta-analysis. No significant reduction in pain was observed immediately after one rTMS treatment session or immediately after the entire schedule of rTMS treatment sessions (5 or 10 sessions; P > 0.05). However, pain significantly reduced 1 week after the entire schedule of rTMS sessions (P < 0.001).

Conclusion: rTMS appears to have a functional analgesic effect in patients with CRPS.

Keywords: complex regional pain syndrome; meta-analysis; pain; repetitive regional pain syndrome.