title: Repetitive transcranial magnetic stimulation is efficacious as an add-on to pharmacological therapy in complex regional pain syndrome (CRPS) type I.
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-) 10 Hz 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Clinic of Pain, Department of Neurology, University of São Paulo, Brazil.
authors.forename: Helder
authors.initials: H
authors.lastname: Picarelli
authors.forename: Manoel Jacobsen
authors.initials: MJ
authors.lastname: Teixeira
authors.forename: Daniel Ciampi
authors.initials: DC
authors.lastname: de Andrade
authors.forename: Martin Luiz
authors.initials: ML
authors.lastname: Myczkowski
authors.forename: Tatiana Barreira
authors.initials: TB
authors.lastname: Luvisotto
authors.forename: Lin Tchia
authors.initials: LT
authors.lastname: Yeng
authors.forename: Erich Talamoni
authors.initials: ET
authors.lastname: Fonoff
authors.forename: Saxby
authors.initials: S
authors.lastname: Pridmore
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: Marcolin
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D010147:Pain Measurement / Q000379:methods; D012019:Reflex Sympathetic Dystrophy / Q000145:classification* / Q000175:diagnosis / Q000188:drug therapy*; D013577:Syndrome; D013997:Time Factors; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000700:Analgesics