title: Repetitive transcranial magnetic stimulation of the left premotor/dorsolateral prefrontal cortex does not have analgesic effect on central poststroke pain.
abstract: Central poststroke pain (CPSP) is caused by an encephalic vascular lesion of the somatosensory pathways and is commonly refractory to current pharmacologic treatments. Repetitive transcranial magnetic stimulation (rTMS) of the premotor cortex/dorsolateral prefrontal cortex (PMC/DLPFC) can change thermal pain threshold toward analgesia in healthy subjects and has analgesic effects in acute postoperative pain as well as in fibromyalgia patients. However, its effect on neuropathic pain and in CPSP, in particular, has not been assessed. The aim of this prospective, double-blind, placebo-controlled study was to evaluate the analgesic effect of PMC/DLPFC rTMS in CPSP patients. Patients were randomized into 2 groups, active (a-) rTMS and sham (s-) rTMS, and were treated with 10 daily sessions of rTMS over the left PMC/DLPFC (10 Hz, 1,250 pulses/d). Outcomes were assessed at baseline, during the stimulation phase, and at 1, 2, and 4 weeks after the last stimulation. The main outcome was pain intensity changes measured by the visual analog scale on the last stimulation day compared to baseline. Interim analysis was scheduled when the first half of the patients completed the study. The study was terminated because of a significant lack of efficacy of the active arm after 21 patients completed the whole treatment and follow-up phases. rTMS of the left PMC/DLPFC did not improve pain in CPSP.
  
  
  CONCLUSIONS
  The aim of this double-blind, placebo-controlled study was to evaluate the analgesic effects of rTMS to the PMC/DLPFC in CPSP patients. An interim analysis showed a consistent lack of analgesic effect, and the study was terminated. rTMS of the PMC/DLPFC is not effective in relieving CPSP.
authors.affiliation: Department of Neurology, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil; Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute, University of São Paulo, São Paulo, Brazil.
authors.forename: Rogério Adas Ayres
authors.initials: RA
authors.lastname: de Oliveira
authors.affiliation: Department of Neurology, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil; Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute, University of São Paulo, São Paulo, Brazil. Electronic address: ciampi@usp.br.
authors.forename: Daniel Ciampi
authors.initials: DC
authors.lastname: de Andrade
authors.affiliation: Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Melina
authors.initials: M
authors.lastname: Mendonça
authors.affiliation: Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Rafael
authors.initials: R
authors.lastname: Barros
authors.affiliation: Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute, University of São Paulo, São Paulo, Brazil; Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Luvisoto
authors.affiliation: Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute, University of São Paulo, São Paulo, Brazil; Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Martin Luiz
authors.initials: ML
authors.lastname: Myczkowski
authors.affiliation: Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute, University of São Paulo, São Paulo, Brazil; Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: Marcolin
authors.affiliation: Department of Neurology, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil; Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute, University of São Paulo, São Paulo, Brazil; Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Manoel Jacobsen
authors.initials: MJ
authors.lastname: Teixeira
mesh_terms: D000328:Adult; D000368:Aged; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D010146:Pain / Q000503:physiopathology*; D059408:Pain Management / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D017288:Pain Threshold / Q000502:physiology; D017397:Prefrontal Cortex / Q000503:physiopathology*; D011446:Prospective Studies; D020521:Stroke / Q000150:complications* / Q000503:physiopathology; D050781:Transcranial Magnetic Stimulation / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
keywords: Central pain; central poststroke pain; dorsolateral prefrontal cortex; repetitive transcranial magnetic stimulation