title: Repetitive transcranial magnetic stimulation and transcranial direct-current stimulation in neuropathic pain due to radiculopathy: a randomized sham-controlled comparative study.
abstract: No study has directly compared the effectiveness of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct-current stimulation (tDCS) in neuropathic pain (NP). In this 2-centre randomised double-blind sham-controlled study, we compared the efficacy of 10-Hz rTMS and anodal 2-mA tDCS of the motor cortex and sham stimulation contralateral to the painful area (3 daily sessions) in patients with NP due to lumbosacral radiculopathy. Average pain intensity (primary outcome) was evaluated after each session and 5 days later. Secondary outcomes included neuropathic symptoms and thermal pain thresholds for the upper limbs. We used an innovative design that minimised bias by randomly assigning patients to 1 of 2 groups: active rTMS and tDCS or sham rTMS and tDCS. For each treatment group (active or sham), the order of the sessions was again randomised according to a crossover design. In total, 51 patients were screened and 35 (51% women) were randomized. Active rTMS was superior to tDCS and sham in pain intensity (F = 2.89 and P = 0.023). Transcranial direct-current stimulation was not superior to sham, but its analgesic effects were correlated to that of rTMS (P = 0.046), suggesting common mechanisms of action. Repetitive transcranial magnetic stimulation lowered cold pain thresholds (P = 0.04) and its effect on cold pain was correlated with its analgesic efficacy (P = 0.006). However, rTMS had no impact on individual neuropathic symptoms. Thus, rTMS is more effective than tDCS and sham in patients with NP due to lumbosacral radiculopathy and may modulate the sensory and affective dimensions of pain.
authors: INSERM U-987, Boulogne-Billancourt, France; CHU Ambroise Paré, GH Paris Ile de France Ouest, APHP, Boulogne-Billancourt, France Université Versailles-Saint-Quentin, Versailles, France EA 4391, Faculté de Médecine de Créteil, Université Paris-Est Créteil, Créteil, France Service de Physiologie, Explorations Fonctionnelles, Hôpital Henri Mondor, Créteil, France Pain Centre, Department of Neurology, University of São Paulo, São Paulo, Brazil.
authors: Nadine
authors: N
authors: Attal
authors: Samar S
authors: SS
authors: Ayache
authors: Daniel
authors: D
authors: Ciampi De Andrade
authors: Alaa
authors: A
authors: Mhalla
authors: Sophie
authors: S
authors: Baudic
authors: Frédérique
authors: F
authors: Jazat
authors: Rechdi
authors: R
authors: Ahdab
authors: Danusa O
authors: DO
authors: Neves
authors: Marc
authors: M
authors: Sorel
authors: Jean-Pascal
authors: JP
authors: Lefaucheur
authors: Didier
authors: D
authors: Bouhassira
mesh_terms: D000328:Adult; D000368:Aged; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D009437:Neuralgia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D059408:Pain Management / Q000379:methods; D011843:Radiculopathy / Q000150:complications* / Q000503:physiopathology; D065908:Transcranial Direct Current Stimulation / Q000379:methods*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome