Transcranial magnetic stimulation as a new tool to control pain perception

Table 1 Summary of the studies evaluating the effects of repetitive transcranial magnetic stimulation on chronic neuropathic pain and non-neuropathic pain

Ref.	Painful syndrome	Study design	Number of patients	Coil	Site stimulation	Frequency, intensity, n sessions	Outcomes	Efficacy
NP
Lefaucheur et al[26]	Intractable neurogenic pain	Double-blind, controlled, crossover	18	F8	Hand M1	0.5-10 Hz	Pain intensity	Analgesic effect (only for 10 Hz)
			(12 central NP; 6 peripheral NP)			80% RMT
						1
Lefaucheur et al[116]	Pain due to thalamic stroke or trigeminal neuropathy	Double-blind, controlled, crossover	14	F8	Hand M1	10 Hz	VAS	Decrease in VAS
			(7 central NP; 7 peripheral NP)			80% RMT
						1
Rollnik et al[41]	Chronic refractory NP	Double-blind, controlled, crossover	12	Double coin - Circular coin	M1	20 Hz	VAS	No effect
			(2 central NP; 7 peripheral NP; 2 CRPS; 1 osteomyelitis)			80% RMT
						1
Lefaucheur et al[27]	Pain do to thalamic stroke, brainstem stroke, spinal cord lesion, brachial plexus lesion, or trigeminal nerve lesion	Double-blind, controlled, crossover	60	F8	Hand M1	10 Hz	VAS, thermal sensory thresholds	Analgesic effect mainly in trigeminal nerve lesions
			(36 central NP; 24 peripheral NP)			80% RMT
						1
Khedr et al[25]	Trigeminal neuralgia and post-stroke pain syndrome	Double-blind, controlled	48	F8	Hand M1	20 Hz	VAS and the LANSS scale	Analgesic effect
			(24 central NP; 24 trigeminal NP)			80% RMT
						5
André-Obadia et al[22]	Chronic refractory NP	Double-blind, controlled, crossover	14	F8	Hand M1	1-20 Hz	VAS	Analgesic effect (only for 20 Hz)
			(11 central NP; 3 peripheral NP)			90% RMT
						1
Hirayama et al[104]	Intractable deafferentation pain	Double-blind, controlled, crossover	20	F8	M1	5 Hz	VAS and SF-MPQ	Analgesic effect
			(14 central NP; 6 peripheral NP)			90% RMT
						1
Irlbarcher et al[117]	Chronic NP	Double-blind, controlled	27	F8	M1	1-5 Hz	VAS	No effect
			(13 central NP; 14 phantom p)			95% RMT
						5
Lefaucheur et al[15]	Unilateral hand pain of various neurologic origins	Double-blind, controlled, crossover	22	F8	Hand M1	10 Hz	Motor threshold at rest, MEP amplitude, CSP, ICI	ICI increase
			(14 central NP; 8 peripheral NP)			90% RMT
						1
Lefaucheur et al[118]	Chronic NP	Double-blind, controlled, crossover	36	F8	Face M1	10 Hz	VAS	Analgesic effect with the stimulation applied on area adjacent to the cortical representation of the painful zone
						80% RMT
						1
Defrin et al[35]	Spinal cord injury	Double-blind, controlled	12	F8	Vertex	5 Hz	VAS, MPQ, pain threshold	Increased heat pain threshold
						115% RMT
						10
Passard et al[29]	Fibromyalgia	Double-blind, controlled	30	F8	M1	10 Hz	VAS, MPQ, quality of life (Brief Pain Inventory and the Fibromyalgia Impact Questionnaire)	Decrease in VAS and better quality of life
						80% RMT
						10
Saitoh et al[115]	Intractable deafferentation pain	Double-blind, controlled, crossover	13	F8	M1	1-5-10 Hz	VAS	Decrease in VAS (only for 5-10 Hz)
			(9 central NP; 4 peripheral NP)			90% RMT
						1
André-Obadia et al[119]	Chronic NP	Double-blind, randomized, controlled, crossover	28	F8	M1	20 Hz	Pain relief, quality of life and rescue drug intake	Analgesic effect
						90% RMT
						1
Lefaucheur et al[120]	Chronic refractory NP	Double-blind, controlled, crossover	46	F8	Hand M1	10 Hz	Thresholds for thermal and mechanical sensations	Thermal perception improvement
			(23 central NP; 23 peripheral NP)			90% RMT
						1
Carretero et al[121]	Fibromyalgia	Randomized, single-blinded	28	Butterfly coil	DLPFC	1 Hz	FibroFatigue, Likert pain, HDRS, CBI	No effect
						110% RMT
						20
Kang et al[36]	Spinal cord injury	Double-blind, controlled, crossover	11	F8	M1	10 Hz	NRS, BPI	No effect
						80% RMT
						5
Picarelli et al[33]	CRPS type 1	Double-blind, controlled	23	F8	M1	10 Hz	VAS, MPQ, the SF-36, HDRS	Analgesic effect and improved quality of life
						90% RMT
						10
Ahmed et al[108]	Phantom pain	Double-blind, controlled	27	F8	DLPFC	20 Hz	VAS, LANSS scale	Decrease in VAS and LANSS scale
						80% RMT
						5
Mhalla et al[38]	Fibromyalgia	Double-blind, controlled	40	F8	M1	10 Hz	Pain intensity over the last 24 h, BPI, quality of life, mood and anxiety, parameters of motor cortical excitability	Analgesic effect
						80% RMT
Short et al[63]	Fibromyalgia	Double-blind, controlled	20	F8	M1	14	BPI, HDRS, Fibromyalgia Impact Questionnaire	Improvement of daily pain, number of tender points, HDRS and FIQ scores
						10 Hz
						120% RMT
Lefaucheur et al[122]	Chronic refractory NP	Controlled, crossover	14	F8	M1	10	VAS	Analgesic effect
			(3 localized in the face, 4 upper limb, 3 lower limb, 4 hemibody)			10 Hz
						90% RMT
						3
Hosomi et al[109]	NP	Double-blind, controlled, crossover	64	F8	M1	50 Hz	VAS, SF-MPQ, PGIC, and BDI	Analgesic effect
						90% RMT
						10
Onesti et al[28]	Diabetic neuropathy	Double-blind, controlled, crossover	23	H-coil	Vertex	20 Hz	VAS, area and threshold of RIII nociceptive flexion reflex RIII reflex	Decrease in VAS and RIII area
						100% RMT
						5
Jetté et al[34]	Spinal cord injury	Randomized, controlled, crossover	16	F8	M1	10 Hz	VAS, motor mapping parameters	Decrease in VAS
						90%-110% RMT
						3
Boyer et al[30]	Fibromyalgia	Double-blind, randomized, controlled	38	F8	M1	10 Hz	FIQ, SF-36, brain metabolism	Improvement of quality of life
						90% RMT
						14
Dall’Agnol et al[123]	Myofascial pain syndrome	Double-blind, randomized, controlled	24	F8	M1	10 Hz	Pain quantitative sensory testing, conditioned pain modulation, TMS parameters, BDNF	Analgesic effect mediated by mechanisms enhancing the corticospinal inhibitory system and BDNF
						80% RMT
						10
Yılmaz et al[40]	Spinal cord injury	Double-blind, randomized, controlled	17	F8	Vertex	10 Hz	VAS	No effect
						110% RMT
						10
Hodaj et al[124]	Chronic refractory facial pain	Open-label study	55	F8	Face M1	10 Hz	VAS, CGIC scale	Analgesic effect
						80% RMT
			(19 cluster headache; 21 trigeminal neuropathic pain; 15 atypical facial pain)			12
Khedr et al[125]	Malignant NP	Randomized, controlled	34	F8	Hand M1	20 Hz	VDS, VAS, LANSS, HDRS	Analgesic effect
						80% RMT
						10
Lindholm et al[126]	Neuropathic orofacial pain	Randomized, controlled, cross-over	16	-	S1/M1, right SII	-	NRS, BPI	Analgesic effect (only for SII)
Non-NP
Brighina et al[46]	Migraine	Double-blind, randomized, controlled	11	F8	DLPFC	10 Hz	Frequency of attacks, Headache index	Significant reduction of outcome measures
						90% RMT
						12
Pleger et al[48]	CRPS	Double-blind, controlled, crossover	10	F8	M1	10 Hz	VAS	Analgesic effect
						110% RMT
						1
Borckardt et al[127]	Postoperative pain	Double-blind, controlled	20	F8	Left PFC	10 Hz	VAS for mood, opioid pump use	Reduction in opioid use
						100% RMT
						1
Johnson et al[49]	Low back pain	Double-blind, controlled, crossover	17	F8	M1	20 Hz	Detection and pain thresholds for cold and heat sensations	Increased heat pain threshold and lowered cold detection
						95% RMT
						1
Fregni et al[50]	Pancreatitis	Double-blind, controlled	17	F8	SII	1 Hz	VAS, BDI	Analgesic effect
						70% RMT
						10 -
Conforto et al[47]	Migraine	Randomized, double-blind, parallel-group	18	-	DLPFC		Number of headache days	No effect
Melchior et al[51]	Irritable bowel syndrome	Double-blind, controlled, crossover	21	F8	M1	20 Hz	Pressure pain threshold, changes in maximum tolerated rectal volume, rectal compliance and average pain intensity	Maximun tolerated rectal volume and analgesic effects
						80% RMT
						5
Avery et al[52]	Chronic widespread pain	Double-blind, randomized, controlled	19	-	DLPFC	-	BIRS	No effect
						15

NP: Neuropathic pain; BPI: Brief pain inventory; FIQ: Fibromyalgia impact questionnaire; F8: Figure of 8 coil; H: Hesed; HDRS: Hamilton depression rating scale; ICI: Intracortical inhibition; LANSS: Leeds assessment of neuropathic symptoms and signs; MPQ: McGill pain questionnaire; PFC: Prefrontal cortex; RIII: Nociceptive flexion reflex; SF-36: 36-item short-form health survey; SICI: Short intracortical inhibition; SII: Somatosensory cortex; VAS: Visual analog scale; MEP: Motor evoked potential; NRS: Numeric rating scale; PGIC: Patient global impression of change scale; BDNF: Brain-derived neurotrophic factor; VDS: Verbal descriptor scale; CGIC: Clinical global impression of change; DLPFC: Dorsolateral prefrontal cortex; BIRS: Gracely box intensity scale.