Comparing the Impact of Multi-Session Left Dorsolateral Prefrontal and Primary Motor Cortex Neuronavigated Repetitive Transcranial Magnetic Stimulation (nrTMS) on Chronic Pain Patients

Repetitive transcranial stimulation (rTMS) has been shown to produce an analgesic effect and therefore has a potential for treating chronic refractory pain. However, previous studies used various stimulation parameters (including cortical targets), and the best stimulation protocol is not yet identi...

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Bibliographic Details
Published in:Brain sciences 2021-07, Vol.11 (8), p.961
Main Authors: Freigang, Sascha, Lehner, Christian, Fresnoza, Shane M., Mahdy Ali, Kariem, Hlavka, Elisabeth, Eitler, Annika, Szilagyi, Istvan, Bornemann-Cimenti, Helmar, Deutschmann, Hannes, Reishofer, Gernot, Berlec, Anže, Kurschel-Lackner, Senta, Valentin, Antonio, Sutter, Bernhard, Zaar, Karla, Mokry, Michael
Format: Article
Language:English
Subjects:
Analgesics
Antidepressants
Back pain
Chronic pain
Cortex (motor)
dorsolateral prefrontal cortex
Fibromyalgia
low back pain
Magnetic fields
Narcotics
neuromodulation
Pain perception
Physical therapy
Placebos
Prefrontal cortex
primary motor cortex
Psychotropic drugs
Quality of life
repetitive transcranial magnetic stimulation
Transcranial magnetic stimulation
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Summary:Repetitive transcranial stimulation (rTMS) has been shown to produce an analgesic effect and therefore has a potential for treating chronic refractory pain. However, previous studies used various stimulation parameters (including cortical targets), and the best stimulation protocol is not yet identified. The present study investigated the effects of multi-session 20 Hz (2000 pulses) and 5 Hz (1800 pulses) rTMS stimulation of left motor cortex (M1-group) and left dorsolateral prefrontal cortex (DLPFC-group), respectively. The M1-group (n = 9) and DLPFC-group (n = 7) completed 13 sessions of neuronavigated stimulation, while a Sham-group (n = 8) completed seven sessions of placebo stimulation. The outcome was measured using the German Pain Questionnaire (GPQ), Depression, Anxiety and Stress Scale (DASS), and SF-12 questionnaire. Pain perception significantly decreased in the DLPFC-group (38.17%) compared to the M1-group (56.11%) (p ≤ 0.001) on the later sessions. Health-related quality of life also improved in the DLPFC-group (40.47) compared to the Sham-group (35.06) (p = 0.016), and mental composite summary (p = 0.001) in the DLPFC-group (49.12) compared to M1-group (39.46). Stimulation of the left DLPFC resulted in pain relief, while M1 stimulation was not effective. Nonetheless, further studies are needed to identify optimal cortical target sites and stimulation parameters.
ISSN:2076-3425
2076-3425
DOI:10.3390/brainsci11080961