Background & Aims

Deep rTMS has recently been of interest when it comes to studying pain relief in chronic peripheral and central neuropathic pain [1–3]. To date, only one study has investigated effects of deep rTMS in chronic peripheral neuropathic pain patients. In that study, patients had painful diabetic polyneuropathy in the lower limbs and received H-coil rTMS targeting the lower limb area of M1 [3]. However, the effects of H-coil rTMS targeting the hand motor area are still unknown for patients with other chronic peripheral neuropathic pain conditions. This study aimed to assess whether deep rTMS, using the H-coil, over the cortical motor hand representation significantly relieved pain in patients with chronic peripheral neuropathic pain compared to sham rTMS. It also aimed to assess whether rTMS could affect symptoms of anxiety and depression, sleep, pain catastrophizing and functionality.

Methods

In total, 17 patients with peripheral neuropathic pain were randomly assigned to receive active or sham deep rTMS, using an H-coil, in a counterbalanced order. Peripheral neuropathic pain conditions included painful radiculopathy, painful polyneuropathy, postherpetic neuralgia and peripheral nerve injury . After a nine-week washout period they crossed over to either active or sham deep rTMS, according to a double-blind cross-over design. Each treatment period consisted of five daily rTMS sessions and a one- and three-week follow-up visit. The primary outcome was change in mean usual pain intensity scores over the last 24 hours between baseline values measured 1 week before rTMS treatment and up to three weeks after rTMS treatment. Secondary outcomes included pain unpleasantness, dynamic and static mechanical allodynia, anxiety and depression, sleep, pain catastrophizing, functionality, and patients’ impression of change.

Results

We found two significant interactions between treatment and time, indicating that active deep rTMS induced significant analgesic effects and significant reductions in anxiety and depression compared to sham over the treatment course. The analgesic effect occurred two weeks after the treatment and the effect on anxiety and depression occurred 3 weeks after treatment . No other significant interactions were found for the secondary variables.

Conclusions

In conclusion, 5 days of H-coil deep rTMS targeting the hand area of the primary motor cortex induced significant effects on pain, anxiety and depression.

References

[1] Bouhassira D, Jazat-Poindessous F, Farnes N, Franchisseur C, Stubhaug A, Bismuth J, Lefaucheur J-P, Hansson P, Attal N. Comparison of the analgesic effects of “ superficial ” and “ deep ” repetitive transcranial magnetic stimulation in patients with central neuropathic pain?: a randomized sham-controlled multicenter international crossover study. Pain 2023.
[2] Lefaucheur J-P, Aleman A, Baeken C, Benninger DH, Brunelin J, Di Lazzaro V, Filipovi? SR, Grefkes C, Hasan A, Hummel FC, Jääskeläinen SK, Langguth B, Leocani L, Londero A, Nardone R, Nguyen J-P, Nyffeler T, Oliveira-Maia AJ, Oliviero A, Padberg F, Palm U, Paulus W, Poulet E, Quartarone A, Rachid F, Rektorová I, Rossi S, Sahlsten H, Schecklmann M, Szekely D, Ziemann U. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014–2018). Clin Neurophysiol 2020;131:474–528. doi:10.1016/J.CLINPH.2019.11.002.
[3] Onesti E, Gabriele M, Cambieri C, Ceccanti M, Raccah R, Di Stefano G, Biasiotta A, Truini A, Zangen A, Inghilleri M. H-coil repetitive transcranial magnetic stimulation for pain relief in patients with diabetic neuropathy. Eur J Pain (United Kingdom) 2013;17:1347–1356.

Presenting Author

Nadine Farnes

Poster Authors

Nadine Farnes

MSc

Oslo University Hospital

Lead Author

E-mail

Audun Stubhaug

Department of Pain Management and Research

Lead Author

E-mail

Per Hansson

Department of Molecular Medicine and Surgery, Karolinska Institutet

Lead Author

E-mail

Sara Vambheim

Department of pain management and research, Oslo university hospital, Norway

Lead Author

E-mail

Topics

  • Treatment/Management: Interventional Therapies – Neuromodulation