Repetitive Transcranial Magnetic Stimulation for Phantom Limb Pain in Land Mine Victims: A Double-Blinded, Randomized, Sham-Controlled Trial.
We evaluated the effects of repetitive transcranial magnetic stimulation (rTMS) in the treatment of phantom limb pain (PLP) in land mine victims. Fifty-four patients with PLP were enrolled in a randomized, double-blinded, placebo-controlled, parallel group single-center trial. The intervention consisted of real or sham rTMS of M1 contralateral to the amputated leg. rTMS was given in series of 20 trains of 6-second duration (54-second intertrain, intensity 90% of motor threshold) at a stimulation rate of 10 Hz (1,200 pulses), 20 minutes per day, during 10 days. For the control group, a sham coil was used. The administration of active rTMS induced a significantly greater reduction in pain intensity (visual analogue scale scores) 15 days after treatment compared with sham stimulation (-53.38 ± 53.12% vs -22.93 ± 57.16%; mean between-group difference = 30.44%, 95% confidence interval, .30-60.58; P = .03). This effect was not significant 30 days after treatment. In addition, 19 subjects (70.3%) attained a clinically significant pain reduction (>30%) in the active group compared with 11 in the sham group (40.7%) 15 days after treatment (P = .03). The administration of 10 Hz rTMS on the contralateral primary motor cortex for 2 weeks in traumatic amputees with PLP induced significant clinical improvement in pain.



High-frequency rTMS on the contralateral primary motor cortex of traumatic amputees induced a clinically significant pain reduction up to 15 days after treatment without any major secondary effect. These results indicate that rTMS is a safe and effective therapy in patients with PLP caused by land mine explosions.
Neurovascular Science Group, Fundación Cardiovascular de Colombia, Floridablanca, Colombia; Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts.
Alejandra
A
Malavera
Neurovascular Science Group, Fundación Cardiovascular de Colombia, Floridablanca, Colombia.
Federico Arturo
FA
Silva
Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts.
Felipe
F
Fregni
Neurovascular Science Group, Fundación Cardiovascular de Colombia, Floridablanca, Colombia.
Sandra
S
Carrillo
Neurovascular Science Group, Fundación Cardiovascular de Colombia, Floridablanca, Colombia; MASIRA Research Institute, School of Medicine, Universidad de Santander, Bucaramanga, Colombia; Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: rgarcia@nmr.mgh.harvard.edu.
Ronald G
RG
Garcia
D000328:Adult; D001007:Anxiety / Q000209:etiology; D003863:Depression / Q000209:etiology; D064891:Disaster Victims / Q000523:psychology / Q000534:rehabilitation; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010591:Phantom Limb / Q000150:complications / Q000523:psychology / Q000534:rehabilitation*; D013997:Time Factors; D050781:Transcranial Magnetic Stimulation / Q000379:methods*
Phantom limb pain; land mine victims; neuropathic pain; noninvasive brain stimulation; rTMS