Repetitive Transcranial Magnetic Stimulation for the Treatment of Chronic Pain – A Pilot StudyRollnik J.D.a · Wüstefeld S.a · Däuper J.a · Karst M.b · Fink M.c · Kossev A.d · Dengler R.a
Departments of aNeurology and Clinical Neurophysiology, bAnesthesiology, Pain Clinic, and cPhysical Medicine and Rehabilitation, Medical School of Hannover, Germany; dDepartment of Biophysics, Bulgarian Academy of Sciences, Sofia, Bulgaria
Do you have an account?
- Rent for 48h to view
- Buy Cloud Access for unlimited viewing via different devices
- Synchronizing in the ReadCube Cloud
- Printing and saving restrictions apply
Rental: USD 8.50
Cloud: USD 20.00
Invasive electrical stimulation of the motor cortex has been reported to be of therapeutic value in pain control. We were interested whether noninvasive repetitive transcranial magnetic stimulation (rTMS) of the primary motor cortex might also act beneficially. Twelve patients with therapy-resistant chronic pain syndromes (mean age 51.3 ± 12.6, 6 males) were included in a pilot study. They were treated with rTMS of the corresponding motor cortex area for 20 min (20 Hz, 20 × 2 s trains, intensity 80% of motor threshold) and sham stimulation (sequence-controlled cross-over design). Some of the patients (6/6) had an analgesic effect, but for the whole group, the difference between active and sham stimulation did not reach a level of significance (active rTMS: mean VAS reduction –4.0 ± 15.6%; sham rTMS: –2.3 ± 8.8%). Further studies using different rTMS stimulation parameters (duration and frequency of rTMS) or stimulation sites (e.g. anterior cingulate gyrus) are strongly encouraged.
© 2002 S. Karger AG, Basel
- Gerhart KD, Yerzierski RP, Fang ZR, Willis WD: Inhibition of primate spinothalamic tract neurons by stimulation in ventral posterior lateral thalamic nucleus: Possible mechanisms. J Neurophysiol 1983;49:406–423.
Lindblom U, Ottoson JO: Influence of pyramidal stimulation upon the relay of course cutaneous afferents in the dorsal horn. Acta Physiol Scand 1957;38:309–318.
- Adams JE, Hosobuchi Y, Fields HL: Stimulation of internal capsule for relief of chronic pain. J Neurosurg 1974;41:740–744.
- Tsubokawa T, Katayama Y, Yamamoto T, Hirayama T, Koyama S: Chronic motor cortex stimulation in patients with thalamic pain. J Neurosurg 1993;78:393–401.
Meyerson BA, Lindblom U, Linderoth B, Lind G, Herregodts P: Motor cortex stimulation as a treatment of trigeminal neuropathic pain. Acta Neurochir 1993;58:150–153.
- Katayama Y, Tsubokawa T, Yamamoto T: Chronic motor cortex stimulation for central deafferentation pain: Experience with bulbar pain secondary to Wallenberg syndrome. Stereotactic Funct Neurosurg 1994;62:295–299.
- Peyron R, Garcia-Larrea L, Deiber MP, Cinotti L, Convers P, Sindou M, Mauguiere F, Laurent B: Electrical stimulation of precentral cortical area in the treatment of central pain: Electrophysiological and PET study. Pain 1995;62:275–286.
- Garcia-Larrea L, Peyron R, Mertens P, Gregoire MC, Lavenne F, Le Bars D, Convers P, Mauguiere F, Sindou M, Laurent B: Electrical stimulation of the motor cortex for pain control: A combined PET scan and electrophysiological study. Pain 1999;83:259–273.
Barker AT, Freeston IL, Jalinous R, Merton PA, Morton, HB: Magnetic stimulation of the human brain. J Physiol 1985;369:3P.
- Brandt SA, Ploner CJ, Meyer BU: Repetitive transcranial magnetic stimulation. Nervenarzt 1997;68:778–784.
- Rollnik JD, Schubert M, Dengler R: Subthreshold prefrontal repetitive transcranial magnetic stimulation reduces motor cortex excitability. Muscle Nerve 2000;23:112–114.
- Geller V, Grisaru N, Abarbanel JM, Lemberg T, Belmaker RH: Slow magnetic stimulation of prefrontal cortex in depression and schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 1997;21:105–110.
George MS, Wassermann EM, Kimbrell TA, Little JT, Williams WE, Danielson AL, Greenberg BD, Hallett M, Post RM: Mood improvement following daily left prefrontal repetitive transcranial magnetic stimulation in patients with depression: A placebo-controlled crossover trial. Am J Psychiatry 1997;12:1752–1756.
- Feinsod M, Kreinin B, Chistyakov A, Klein E: Preliminary evidence for a beneficial effect of low-frequency, repetitive transcranial magnetic stimulation in patients with major depression and schizophrenia. Depress Anxiety 1998;7:65–68.
- Rollnik JD, Huber TJ, Mogk H, Siggelkow S, Kropp S, Dengler R, Emrich HM, Schneider U: High frequency repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex in schizophrenic patients. Neuroreport 2000;11:4013–4015.
- Siebner HR, Tormos JM, Ceballos-Baumann AO, Auer C, Catala MD, Conrad B, Pascual-Leone A: Low-frequency repetitive transcranial magnetic stimulation of the motor cortex in writer’s cramp. Neurology 1999;52:529–537.
- Johnson DA, Heather BB: The sensitivity of the Beck Depression Inventory to changes of symptomatology. Br J Psychiatry 1974;125:184–185.
- Claus D: Central motor conduction: Method and normal results. Muscle Nerve 1990;13:1125–1132.
- Schubert M, Wohlfarth K, Rollnik JD, Dengler R: Walking and fatigue in multiple sclerosis: The role of the corticospinal system. Muscle Nerve 1998;21:1068–1070.
- Rollnik JD, Tanneberger O, Schubert M, Schneider U, Dengler R: Treatment of tension-type headache with botulinum toxin type A – A double-blind placebo-controlled study. Headache 2000;40:300–305.
Article / Publication Details
Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.