title: Effect of Deep Intramuscular Stimulation and Transcranial Magnetic Stimulation on Neurophysiological Biomarkers in Chronic Myofascial Pain Syndrome.
abstract: OBJECTIVE
  The aim was to assess the neuromodulation techniques effects (repetitive transcranial magnetic stimulation [rTMS] and deep intramuscular stimulation therapy [DIMST]) on pain intensity, peripheral, and neurophysiological biomarkers chronic myofascial pain syndrome (MPS) patients.
  
  
  METHODS
  Randomized, double blind, factorial design, and controlled placebo-sham clinical trial.
  
  
  METHODS
  Clinical trial in the Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (NCT02381171).
  
  
  METHODS
  We recruited women aged between 19- and 75-year old, with MPS diagnosis.
  
  
  METHODS
  Patients were randomized into four groups: rTMS + DIMST, rTMS + sham-DIMST, sham-rTMS + DIMST, sham-rTMS + sham-DIMST; and received 10 sessions for 20 minutes each one (rTMS and DIMST). Pain was assessed by visual analogue scale (VAS); neurophysiological parameters were assessed by transcranial magnetic stimulation; biochemical parameters were: BDNF, S100β, lactate dehydrogenase, inflammatory (TNF-α, IL6, and IL10), and oxidative stress parameters.
  
  
  RESULTS
  We observed the pain relief assessed by VAS immediately assessed before and after the intervention (P < 0.05, F(1,3)= 3.494 and F(1,3)= 4.656, respectively); in the sham-rTMS + DIMST group and both three active groups in relation to sham-rTMS + sham-DIMST group, respectively. There was an increase in the MEP after rTMS + sham-DIMST (P < 0.05). However, there was no change in all-peripheral parameters analyzed across the treatment (P > 0.05).
  
  
  CONCLUSIONS
  Our findings add additional evidence about rTMS and DIMST in relieving pain in MPS patients without synergistic effect. No peripheral biomarkers reflected the analgesic effect of both techniques; including those related to cellular damage. Additionally, one neurophysiological parameter (increased MEP amplitude) needs to be investigated.
authors.forename: Liciane F
authors.initials: LF
authors.lastname: Medeiros
authors.forename: Wolnei
authors.initials: W
authors.lastname: Caumo
authors.forename: Jairo
authors.initials: J
authors.lastname: Dussán-Sarria
authors.forename: Alicia
authors.initials: A
authors.lastname: Deitos
authors.forename: Aline
authors.initials: A
authors.lastname: Brietzke
authors.forename: Gabriela
authors.initials: G
authors.lastname: Laste
authors.forename: Cristina
authors.initials: C
authors.lastname: Campos-Carraro
authors.forename: Andressa
authors.initials: A
authors.lastname: de Souza
authors.forename: Vanessa L
authors.initials: VL
authors.lastname: Scarabelot
authors.forename: Stefania G
authors.initials: SG
authors.lastname: Cioato
authors.forename: Rafael
authors.initials: R
authors.lastname: Vercelino
authors.forename: Alexandre L
authors.initials: AL
authors.lastname: de Castro
authors.forename: Alex Sander
authors.initials: AS
authors.lastname: Araújo
authors.forename: Adriane
authors.initials: A
authors.lastname: Belló-Klein
authors.forename: Felipe
authors.initials: F
authors.lastname: Fregni
authors.forename: Iraci L S
authors.initials: IL
authors.lastname: Torres
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D015415:Biomarkers / Q000032:analysis; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008875:Middle Aged; D009209:Myofascial Pain Syndromes / Q000628:therapy*; D059408:Pain Management / Q000379:methods; D050781:Transcranial Magnetic Stimulation / Q000379:methods; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism; D055815:Young Adult
chemical_list: D000700:Analgesics; D015415:Biomarkers; D014409:Tumor Necrosis Factor-alpha