title: The effect of repetitive transcranial magnetic stimulation on refractory neuropathic pain in spinal cord injury.
abstract: OBJECTIVE
  To investigate the analgesic effect of repetitive transcranial magnetic stimulation (rTMS) on intractable neuropathic pain in patients with spinal cord injury (SCI).
  
  
  METHODS
  A single center, prospective, randomized, double-blinded, controlled study.
  
  
  METHODS
  SCI rehabilitation unit of university rehabilitation center.
  
  
  METHODS
  Seventeen patients with SCI and chronic neuropathic pain who met the inclusion criteria recruited between April 2010 and January 2012.
  
  
  METHODS
  Ten daily treatment sessions of real or sham rTMS (30 trains of 10-Hz stimuli for a duration of 5 seconds; a total of 1500 pulses at intensity equal to 110% of the resting motor threshold) was applied over vertex using a ﬁgure-of-8-shaped coil.
  
  
  METHODS
  Pain was assessed with visual analog scale (VAS) at baseline and 10 days, 6 weeks and 6 months after the treatment. Patients' satisfactions obtained using a 5-point Likert scale at 6 months.
  
  
  RESULTS
  Both real and sham rTMS provided a significant reduction in the VAS scores (real rTMS group, P = 0.004; sham rTMS group, P = 0.020). Post hoc analysis revealed the significant difference was at 10 days and 6 weeks compared to baseline in the real rTMS group and only at 10 days compared to baseline in the sham rTMS group. Comparison of VAS scores and patient satisfaction did not show any significant difference at each assessment point (P > 0.05).
  
  
  CONCLUSIONS
  Our results demonstrated analgesic effect of rTMS on intractable neuropathic pain in SCI was not superior to placebo. However, middle-term (over 6 weeks) pain relief by rTMS is encouraging and suggests the need for future studies with a larger sample size.
authors.forename: Bilge
authors.initials: B
authors.lastname: Yılmaz
authors.forename: Serdar
authors.initials: S
authors.lastname: Kesikburun
authors.forename: Evren
authors.initials: E
authors.lastname: Yaşar
authors.forename: Arif Kenan
authors.initials: AK
authors.lastname: Tan
mesh_terms: D000328:Adult; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000209:etiology* / Q000628:therapy*; D013119:Spinal Cord Injuries / Q000150:complications*; D013997:Time Factors; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D064232:Visual Analog Scale
keywords: Pain; Repetitive transcranial magnetic stimulation; Spinal cord injury