The effect of a series of repetitive transcranial magnetic stimulations of the motor cortex on central pain after spinal cord injury.
OBJECTIVE
To study the analgesic effect of repetitive transcranial magnetic stimulation (rTMS) of the motor cortex on central pain in patients with chronic spinal cord injury (SCI).


METHODS
Double-blind randomized controlled trial. Mean follow-up period was 4.5 weeks.


METHODS
General hospital.


METHODS
Twelve paraplegic patients due to thoracic SCI suffering chronic central pain (11 completed the study) who were randomly selected from a list of eligible patients.


METHODS
Real or sham 10 daily motor rTMS treatments (500 trains at 5 Hz for 10 s; total of 500 pulses at intensity of 115% of motor threshold) using figure-of-8 coil over the vertex.


METHODS
Chronic pain intensity (visual analog scale [VAS], McGill Pain Questionnaire [MPQ]), pain threshold, and level of depression (Beck Depression Inventory).


RESULTS
Both real and sham TMS induced a similar, significant reduction in VAS scores (P<.001) immediately after each of the 10 treatment sessions and in VAS and MPQ scores after the end of the treatment series. However, only real rTMS conferred a significant increase in heat-pain threshold (4 degrees C, P<.05) by the end of the series. Most important, the reduction in MPQ scores in the real rTMS group continued during the follow-up period. Depression scores were equally reduced in both groups but similar to pain relief, depression continued to improve at follow-up in the real rTMS group.


CONCLUSIONS
Whereas the pain alleviation induced by a single rTMS treatment is probably due to placebo, patients with SCI may benefit from a series of rTMS treatments.
Department of Physical Therapy, Sackler Medical School, Tel-Aviv University, Ramat Aviv, Israel. rutidef@post.tau.ac.il
Ruth
R
Defrin
Leon
L
Grunhaus
Doron
D
Zamir
Gabi
G
Zeilig
D000328:Adult; D002908:Chronic Disease; D003863:Depression / Q000209:etiology / Q000628:therapy; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006358:Hot Temperature; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex; D010146:Pain / Q000145:classification / Q000209:etiology* / Q000534:rehabilitation; D010147:Pain Measurement; D013119:Spinal Cord Injuries / Q000150:complications* / Q000534:rehabilitation; D050781:Transcranial Magnetic Stimulation / Q000009:adverse effects / Q000379:methods*