title: Right secondary somatosensory cortex-a promising novel target for the treatment of drug-resistant neuropathic orofacial pain with repetitive transcranial magnetic stimulation.
abstract: High-frequency repetitive transcranial magnetic stimulation (rTMS) of the motor cortex has analgesic effect; however, the efficacy of other cortical targets and the mode of action remain unclear. We examined the effects of rTMS in neuropathic orofacial pain, and compared 2 cortical targets against placebo. Furthermore, as dopaminergic mechanisms modulate pain responses, we assessed the influence of the functional DRD2 gene polymorphism (957C>T) and the catechol-O-methyltransferase (COMT) Val158Met polymorphism on the analgesic effect of rTMS. Sixteen patients with chronic drug-resistant neuropathic orofacial pain participated in this randomized, placebo-controlled, crossover study. Navigated high-frequency rTMS was given to the sensorimotor (S1/M1) and the right secondary somatosensory (S2) cortices. All subjects were genotyped for the DRD2 957C>T and COMT Val158Met polymorphisms. Pain, mood, and quality of life were monitored throughout the study. The numerical rating scale pain scores were significantly lower after the S2 stimulation than after the S1/M1 (P = 0.0071) or the sham (P = 0.0187) stimulations. The Brief Pain Inventory scores were also lower 3 to 5 days after the S2 stimulation than those at pretreatment baseline (P = 0.0127 for the intensity of pain and P = 0.0074 for the interference of pain) or after the S1/M1 (P = 0.001 and P = 0.0001) and sham (P = 0.0491 and P = 0.0359) stimulations. No correlations were found between the genetic polymorphisms and the analgesic effect in the present small clinical sample. The right S2 cortex is a promising new target for the treatment of neuropathic orofacial pain with high-frequency rTMS.
authors.affiliation: Department of Neurology, Turku University Hospital, Salo Hospital, University of Turku, Turku, Finland Departments of Clinical Neurophysiology, and Psychiatry, Turku University Hospital, University of Turku, Turku, Finland Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland Department of Statistics, University of Turku, Turku, Finland Institute of Dentistry, University of Turku, Turku, Finland Pain Clinic, Turku University Hospital, University of Turku, Turku, Finland Department of Physiology, Institute of Biomedicine, University of Helsinki, Helsinki, Finland Department of Diagnostic Radiology, Turku University Hospital, University of Turku, Turku, Finland.
authors.forename: Pauliina
authors.initials: P
authors.lastname: Lindholm
authors.forename: Salla
authors.initials: S
authors.lastname: Lamusuo
authors.forename: Tero
authors.initials: T
authors.lastname: Taiminen
authors.forename: Ullamari
authors.initials: U
authors.lastname: Pesonen
authors.forename: Ari
authors.initials: A
authors.lastname: Lahti
authors.forename: Arja
authors.initials: A
authors.lastname: Virtanen
authors.forename: Heli
authors.initials: H
authors.lastname: Forssell
authors.forename: Jarmo
authors.initials: J
authors.lastname: Hietala
authors.forename: Nora
authors.initials: N
authors.lastname: Hagelberg
authors.forename: Antti
authors.initials: A
authors.lastname: Pertovaara
authors.forename: Riitta
authors.initials: R
authors.lastname: Parkkola
authors.forename: Satu
authors.initials: S
authors.lastname: Jääskeläinen
mesh_terms: D000328:Adult; D000368:Aged; D018592:Cross-Over Studies; D005157:Facial Pain / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods*; D016037:Single-Blind Method; D013003:Somatosensory Cortex / Q000502:physiology*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome
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