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Sessions of Prolonged Continuous Theta Burst Stimulation or High-frequency 10 Hz Stimulation to Left Dorsolateral Prefrontal Cortex for 3 Days Decreased Pain Sensitivity by Modulation of the Efficacy of Conditioned Pain Modulation

  • Enrico De Martino
    Affiliations
    Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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  • Ana Mércia Fernandes
    Affiliations
    Pain Center, LIM-62, Department of Neurology, University of São Paulo, São Paulo, Brazil
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  • Ricardo Galhardoni
    Affiliations
    Pain Center, LIM-62, Department of Neurology, University of São Paulo, São Paulo, Brazil

    Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry (INBioN), Department and Institute of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil

    School of Medicine, University of City of São Paulo (UNICID), São Paulo, Brazil
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  • Carolina De Oliveira Souza
    Affiliations
    Movement Disorders Clinic, Department of Neurology, Hospital das Clinicas of the University of São Paulo School of Medicine, São Paulo, Brazil
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  • Daniel Ciampi De Andrade
    Affiliations
    Pain Center, LIM-62, Department of Neurology, University of São Paulo, São Paulo, Brazil

    Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry (INBioN), Department and Institute of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil

    Pain Center, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
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  • Author Footnotes
    a http://www.cnap.hst.aau.dk/∼tgn
    Thomas Graven-Nielsen
    Correspondence
    Address reprint requests to Thomas Graven-Nielsen, DMSc, PhD, Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 7D-3, 9220 Aalborg E, Denmark.
    Footnotes
    a http://www.cnap.hst.aau.dk/∼tgn
    Affiliations
    Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
    Search for articles by this author
  • Author Footnotes
    a http://www.cnap.hst.aau.dk/∼tgn

      Highlights

      • The 10 Hz repetitive transcranial magnetic stimulation and prolonged continuous TBS to the left dorsolateral prefrontal cortex increased pain thresholds up to 24-hours.
      • Increased pain thresholds were partially associated with modulation of conditioned pain modulation efficacy.
      • Increased pain thresholds were not correlated to intracortical excitability changes.

      Abstract

      The 10 Hz repetitive transcranial magnetic stimulation (10 Hz-rTMS) to the left dorsolateral prefrontal cortex produces analgesia, probably by activating the pain modulation system. A newer rTMS paradigm, called theta burst stimulation (TBS), has been developed. Unlike 10 Hz-rTMS, prolonged continuous TBS (pcTBS) mimics endogenous theta rhythms, which can improve induction of synaptic long-term potentiation. Therefore, this study investigated whether pcTBS to the left dorsolateral prefrontal cortex reduced pain sensitivity more efficiently compared with 10 Hz-rTMS, the analgesic effects lasted beyond the stimulation period, and the reduced pain sensitivity was associated with increased efficacy of conditioned pain modulation (CPM) and/or intracortical excitability. Sixteen subjects participated in a randomized cross-over study with pcTBS and 10 Hz-rTMS. Pain thresholds to heat (HPT), cold, pressure (PPT), intracortical excitability assessment, and CPM with mechanical and heat supra-pain threshold test stimuli and the cold pressor test as conditioning were collected before (Baseline), 3 (Day3) and 4 days (Day4) after 3-day session of rTMS. HPTs and PPTs increased with 10 Hz-rTMS and pcTBS at Day3 and Day4 compared with Baseline (P = .007). Based on pooled data from pcTBS and 10 Hz-rTMS, the increased PPTs correlated with increased efficacy of CPM at Day3 (P = .008), while no correlations were found at Day4 or with the intracortical excitability.

      Perspective

      Preliminary results of this comparative study did not show stronger pain sensitivity reduction by pcTBS compared with 10 Hz-rTMS to the L-DPFC. Both protocols maintained increased pain thresholds up to 24-hours after the last session, which were partially associated with modulation of CPM efficacy but not with the intracortical excitability changes.

      Key words

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