Transcranial Magnetic Stimulation for Chronic Pain

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Key points

  • 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

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

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