- •
Current data suggest that transcranial magnetic stimulation (TMS) has the potential to be an effective and complimentary treatment of patients with chronic neuropathic pain syndromes.
- •
The success of TMS for pain relief depends on the parameters of the stimulation delivered, the location of the neural target, and the duration of the treatment.
- •
TMS can be used to excite or inhibit underlying neural tissue that depends on long-term potentiation and long-term depression respectively.
- •
Multiple sessions
Transcranial Magnetic Stimulation for Chronic Pain
Section snippets
Key points
Mechanism of action and parameters of rTMS relevant to chronic pain management
The technique of TMS was introduced in the 1950s, but it was not until the introduction of noninvasive magnetic stimulation by Barker and colleagues21 in 1985 that the scope of this therapy was widened. Since then TMS has been evaluated for refractory depression, chronic pain, neuropathic pain, schizophrenia, and obsessive compulsive disorders, with varied success.15, 16, 22, 23, 24 TMS involves generation of action potentials with either activation or inhibition of various cortical and
Safety profile of TMS
The excellent safety profile of TMS is the major advantage of this noninvasive treatment modality and led to the expansion of this therapy for a variety of indications. The most serious of the reported complications is the occurrence of seizures, and most of these complications occurred either because of nonadherence to recommended stimulation parameters or in patients who were on medications (tricyclic antidepressants, antipsychotics, theophylline, cocaine, alcohol, amphetamines, MDMA
TMS for chronic pain
High-frequency rTMS of the M1 has been shown to induce rapid changes and modulation of the sensorimotor networks in healthy individuals.25 High-frequency rTMS has also been shown to have a direct effect on sensory thresholds for both cold and hot temperature sensations and thus may be effective in alleviating symptoms in patients with chronic pain.55 Low-frequency rTMS (1 Hz) over the M1 has been shown to induce early recovery from capsaicin-induced acute pain mediated by C fibers in healthy
TMS for fibromyalgia
Fibromyalgia syndrome (FMS) is the second most common rheumatologic disorder, affecting approximately 4 to 10 million people in the United States.9, 20, 88, 89, 90, 91 According to the American college of Rheumatology (ACR) in 1990 the diagnosis of FMS requires the presence of chronic diffuse pain and painful response to 11 of 18 tender points.92 Other symptoms include excessive fatigue, nonrestorative sleep, mood and cognitive disturbances, and diminished physical reserves.20, 92, 93 FMS is
TMS for migraine
Migraine is a debilitating condition with prevalence of 11.7% in the general population.101 This condition is more prevalent in women (17.1%) compared with men (5.6%).101 Migrainous attacks may or may not be associated or preceded by transient neurologic symptoms and are classified as with or without aura, respectively. Based on animal studies, altered cortical excitability has been implicated in the pathophysiology of migraine.102, 103, 104 There are conflicting reports of hyperexcitability or
Summary
rTMS has been shown to have significant analgesic effects and can be used as a complementary treatment modality in patients with chronic refractory pain syndromes such as poststroke pain (thalamic/brainstem), trigeminal neuropathy pain, nerve root/brachial plexus avulsion pain, spinal cord injury pain, fibromyalgia, or migraine. The efficacy of rTMS according to the diagnosis of different pain syndromes has not yet been elucidated. In terms of cortical targets, high-frequency stimulation of M1
References (116)
- et al.
The prevalence of chronic pain in United States adults: results of an Internet-based survey
J Pain
(2010) - et al.
Prevalence and characteristics of chronic pain in the general population of Hong Kong
J Pain
(2011) - et al.
The epidemiology of chronic pain of predominantly neuropathic origin. Results from a general population survey
J Pain
(2006) - et al.
The economic costs of pain in the United States
J Pain
(2012) - et al.
Relieving pain in rheumatology patients: Repetitive transcranial magnetic stimulation (rTMS), a developing approach
Joint Bone Spine
(2014) - et al.
Motor and parietal cortex stimulation for phantom limb pain and sensations
Pain
(2013) The use of repetitive transcranial magnetic stimulation (rTMS) in chronic neuropathic pain
Neurophysiol Clin
(2006)- et al.
The use of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) to relieve pain
Brain Stimul
(2008) - et al.
Non-invasive magnetic stimulation of human motor cortex
Lancet
(1985) - et al.
High frequency rTMS modulation of the sensorimotor networks: behavioral changes and fMRI correlates
Neuroimage
(2008)
A theoretical calculation of the electric field induced in the cortex during magnetic stimulation
Electroencephalogr Clin Neurophysiol
Different sites of action of electrical and magnetic stimulation of the human brain
Neurosci Lett
A comparison of corticospinal activation by magnetic coil and electrical stimulation of monkey motor cortex
Electroencephalogr Clin Neurophysiol
Modulation of cortical excitability induced by repetitive transcranial magnetic stimulation: influence of timing and geometrical parameters and underlying mechanisms
Prog Neurobiol
A comprehensive review of the effects of rTMS on motor cortical excitability and inhibition
Clin Neurophysiol
A direct demonstration of cortical LTP in humans: a combined TMS/EEG study
Brain Res Bull
Long-term maintenance of the analgesic effects of transcranial magnetic stimulation in fibromyalgia
Pain
Optimal parameters for microstimulation derived forelimb movement thresholds and motor maps in rats and mice
J Neurosci Methods
Theta burst stimulation of the human motor cortex
Neuron
Neuropharmacological basis of rTMS-induced analgesia: the role of endogenous opioids
Pain
French guidelines on the use of repetitive transcranial magnetic stimulation (rTMS): safety and therapeutic indications
Neurophysiol Clin
Changes to somatosensory detection and pain thresholds following high frequency repetitive TMS of the motor cortex in individuals suffering from chronic pain
Pain
Effects of 1-Hz repetitive transcranial magnetic stimulation on acute pain induced by capsaicin
Pain
High-frequency rTMS of the motor cortex does not influence the nociceptive flexion reflex but increases the unpleasantness of electrically induced pain
Neurosci Lett
Transcranial magnetic stimulation (TMS) of the sensorimotor cortex and medial frontal cortex modifies human pain perception
Clin Neurophysiol
Modulation of electrically induced pain by paired pulse transcranial magnetic stimulation of the medial frontal cortex
Clin Neurophysiol
Repetitive transcranial magnetic stimulation of dorsolateral prefrontal cortex increases tolerance to human experimental pain
Brain Res Cogn Brain Res
Interventional neurophysiology for pain control: duration of pain relief following repetitive transcranial magnetic stimulation of the motor cortex
Neurophysiol Clin
Neuropathic pain controlled for more than a year by monthly sessions of repetitive transcranial magnetic stimulation of the motor cortex
Neurophysiol Clin
Motor cortex rTMS reduces acute pain provoked by laser stimulation in patients with chronic neuropathic pain
Clin Neurophysiol
Repetitive transcranial magnetic stimulation of the motor cortex attenuates pain perception in complex regional pain syndrome type I
Neurosci Lett
Repetitive transcranial magnetic stimulation is efficacious as an add-on to pharmacological therapy in complex regional pain syndrome (CRPS) type I
J Pain
Transcranial magnetic stimulation for pain control. Double-blind study of different frequencies against placebo, and correlation with motor cortex stimulation efficacy
Clin Neurophysiol
Daily repetitive transcranial magnetic stimulation of primary motor cortex for neuropathic pain: a randomized, multicenter, double-blind, crossover, sham-controlled trial
Pain
Repetitive transcranial magnetic stimulation of the parietal cortex transiently ameliorates phantom limb pain-like syndrome
Clin Neurophysiol
Reduction of intractable deafferentation pain by navigation-guided repetitive transcranial magnetic stimulation of the primary motor cortex
Pain
Significant analgesic effects of one session of postoperative left prefrontal cortex repetitive transcranial magnetic stimulation: a replication study
Brain Stimul
Fibromyalgia syndrome in the general population of France: a prevalence study
Joint Bone Spine
Prevalence of fibromyalgia: a survey in five European countries
Semin Arthritis Rheum
Guidelines on the management of fibromyalgia syndrome - a systematic review
Eur J Pain
Ten sessions of adjunctive left prefrontal rTMS significantly reduces fibromyalgia pain: a randomized, controlled pilot study
Pain
Epidemiology of neuropathic pain and its impact on quality of life
Curr Pain Headache Rep
An overview of neuropathic pain: syndromes, symptoms, signs, and several mechanisms
Clin J Pain
Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms
Biology and therapy of fibromyalgia. Functional magnetic resonance imaging findings in fibromyalgia
Arthritis Res Ther
Chronic motor cortex stimulation for the treatment of central pain
Acta Neurochir Suppl (Wien)
Motor cortex stimulation for chronic non-malignant pain: current state and future prospects
Acta Neurochir Suppl
Invasive brain stimulation for the treatment of neuropathic pain. Nature reviews
Neurology
Non-invasive brain stimulation techniques for chronic pain
Cochrane Database Syst Rev
Neurogenic pain relief by repetitive transcranial magnetic cortical stimulation depends on the origin and the site of pain
J Neurol Neurosurg Psychiatr
Cited by (0)
- 1
Contributed equally.