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Analgesic effects of repetitive transcranial magnetic stimulation of the motor cortex in neuropathic pain: Influence of theta burst stimulation priming
Author(s) -
Lefaucheur J.P.,
Ayache S.S.,
Sorel M.,
Farhat W.H.,
Zouari H.G.,
Ciampi de Andrade D.,
Ahdab R.,
MénardLefaucheur I.,
Brugières P.,
Goujon C.
Publication year - 2012
Publication title -
european journal of pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.305
H-Index - 109
eISSN - 1532-2149
pISSN - 1090-3801
DOI - 10.1002/j.1532-2149.2012.00150.x
Subject(s) - transcranial magnetic stimulation , analgesic , neuropathic pain , stimulation , psychology , priming (agriculture) , anesthesia , motor cortex , neuromodulation , medicine , neuroscience , botany , germination , biology
Background ‘Conventional’ protocols of high‐frequency repetitive transcranial magnetic stimulation (r TMS ) delivered to M 1 can produce analgesia. Theta burst stimulation ( TBS ), a novel r TMS paradigm, is thought to produce greater changes in M 1 excitability than ‘conventional’ protocols. After a preliminary experiment showing no analgesic effect of continuous or intermittent TBS trains (c TBS or i TBS ) delivered to M 1 as single procedures, we used TBS to prime a subsequent session of ‘conventional’ 10 H z‐r TMS . Methods In 14 patients with chronic refractory neuropathic pain, navigated r TMS was targeted over M 1 hand region, contralateral to painful side. Analgesic effects were daily assessed on a visual analogue scale for the week after each 10 H z‐r TMS session, preceded or not by TBS priming. In an additional experiment, the effects on cortical excitability parameters provided by single‐ and paired‐pulse TMS paradigms were studied. Results Pain level was reduced after any type of r TMS procedure compared to baseline, but i TBS priming produced greater analgesia than the other protocols. Regarding motor cortex excitability changes, the analgesic effects were associated with an increase in intracortical inhibition, whatever the type of stimulation, primed or non‐primed. Conclusions The present results show that the analgesic effects of ‘conventional’ 10 H z‐r TMS delivered to M 1 can be enhanced by TBS priming, at least using i TBS . Interestingly, the application of c TBS and i TBS did not produce opposite modulations, unlike previously reported in other systems. It remains to be determined whether the interest of TBS priming is to generate a simple additive effect or a more specific process of cortical plasticity.