Abstract
Single-session repetitive transcranial magnetic stimulation (rTMS) of the motor cortex
(M1) is effective in the treatment of chronic pain patients, but the analgesic effect
of repeated sessions is still unknown. We evaluated the effects of rTMS in patients
with refractory pain due to complex regional pain syndrome (CRPS) type I. Twenty-three
patients presenting CRPS type I of 1 upper limb were treated with the best medical
treatment (analgesics and adjuvant medications, physical therapy) plus 10 daily sessions
of either real (r-) or sham (s-) 10Hz rTMS to the motor cortex (M1). Patients were
assessed daily and after 1 week and 3 months after the last session using the Visual
Analogical Scale (VAS), the McGill Pain Questionnaire (MPQ), the Health Survey-36
(SF-36), and the Hamilton Depression (HDRS). During treatment there was a significant
reduction in the VAS scores favoring the r-rTMS group, mean reduction of 4.65 cm (50.9%)
against 2.18 cm (24.7%) in the s-rTMS group. The highest reduction occurred at the
tenth session and correlated to improvement in the affective and emotional subscores
of the MPQ and SF-36. Real rTMS to the M1 produced analgesic effects and positive
changes in affective aspects of pain in CRPS patients during the period of stimulation.
Perspective
This study shows an efficacy of repetitive sessions of high-frequency rTMS as an add-on
therapy to refractory CRPS type I patients. It had a positive effect in different
aspects of pain (sensory-discriminative and emotional-affective). It opens the perspective
for the clinical use of this technique.
Key words
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Article info
Publication history
Published online: April 29, 2010
Accepted:
February 17,
2010
Received in revised form:
January 25,
2010
Received:
January 5,
2010
Footnotes
Supported by the Department of Neurology of the University of São Paulo, Brazil.
Identification
Copyright
© 2010 American Pain Society. Published by Elsevier Inc. All rights reserved.
