Article

Effect of repetitive transcranial magnetic stimulation
over the hand motor cortical area on central pain after spinal cord injury.
OBJECTIVE: To evaluate the analgesic effect of repetitive transcranial magnetic
stimulation (rTMS) applied on the hand motor cortical area in patients with
spinal cord injury (SCI) who have chronic neuropathic pain at multiple sites in
the body, including the lower limbs, trunk, and pelvis. DESIGN: Blinded,
randomized crossover study. SETTING: University hospital outpatient setting.
PARTICIPANTS: Patients (N=13) with motor complete or incomplete SCI and chronic
central pain (11 completed the study). INTERVENTIONS: rTMS was applied on the
hand motor cortical area using a figure-of-eight coil. One thousand stimuli were
applied daily on 5 consecutive days. Real and sham rTMS were separated by 12
weeks. MAIN OUTCOME MEASURES: Numeric rating scale (NRS) for average and worst
pain and the Brief Pain Inventory (BPI). RESULTS: At 1 week after the end of the
rTMS period, the average NRS scores changed from 6.45+/-2.25 to 5.45+/-1.81 with
real stimulation and from 6.18+/-1.83 to 5.91+/-2.07 with sham stimulation, and
did not differ between treatments. The interference items of the BPI also did not
differ between the real and sham rTMS. The effect of time on the NRS score for
worst pain was significant with real stimulation but not with sham stimulation.
CONCLUSIONS: The therapeutic efficacy of rTMS was not demonstrated when rTMS was
applied to the hand motor cortical area in patients with chronic neuropathic pain
at multiple sites in the body, including the lower limbs, trunk, and pelvis.
However, the results for worst pain reduction suggest that further studies are
required in which rTMS is applied with a more intensive stimulation protocol.

Langue : ANGLAIS