Effect and reliability of Transcranial Magnetic Stimulation on neuropathic pain, depressive symptoms in stroke patients: Preliminary Study

Abstract

Objective:  In this paper, we aimed to evaluate the effect of repetitive Transcranial Magnetic Stimulation (rTMS) on central pain in patients with stroke. Material and Methods: Ten patients who had a stroke history were included in this preliminary study. Patients with middle cerebral artery lesion, first-time stroke, subacute or chronic lesion and no other neurological involvement were included. Patients were examined before and after the first month of treatment with repetitive Transcranial Magnetic Stimulation (rTMS). Visual Analog Scale (VAS) was used for pain scale measurement; Leeds Assessment of Neuropathic Symptoms and Signs Scale (LANSS) and Douleur Neuropathique en 4 Questions (DN4) were used for neuropathic pain level and Beck Depression Inventory (BDI) for depressive mood. All patients received the current treatments and appropriate neurorehabilitation as recommended for the treatment of ischemic stroke Results: This prospective study included a total of 10 post-stroke patients (mean age 58.2 ± 16.1 years; range 29 to 75, 8 male; 2 female) with neuropathic pain. The mean values of VAS, LANSS, DN4 and BDI scales were significantly decreased after rTMS treatment in all patients. Conclusion: We discussed the preliminary results of the efficacy and safety of rTMS in the treatment of uncontrolled neuropathic pain. We consider that, rTMS may have significant effect on relief of chronic pain. These clinical parameters can be utilized for the further study of rTMS application in pain control.

Keywords

• Transcranial magnetic stimulation,stroke,pain

References

1. 1. Harrison RA, Field TS. Post stroke pain: identification, assessment, and therapy. Cerebrovasc Dis 2015; 39(3-4): 190-201.
2. 2. Frese A, Husstedt IW, Ringelstein EB, Evers S. Pharmacologic treatment of central post-stroke pain. Clin. J. Pain 2006; 22: 252–260.
3. 3. Attal N, Cruccu G, Baron R, Haanpaa M, Hansson P, Jensen TS et al. European Federation of Neurological. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol 2010; 17: 1113–1188.
4. 4. Klein MM, Treister R, Raij T, Pascual-Leone A, Park L, Nurmikko T et al. Transcranial magnetic stimulation of the brain: guidelines for pain treatment research. Pain 2015;156 (9): 1601-1614.
5. 5. Lefaucheur JP, Andre´-Obadia N, Poulet E, Devanne H, Haffen E, Londero A et al. French guidelines on the use of repetitive transcranial magnetic stimulation (rTMS): safety and therapeutic indications (French). Neurophysiol Clin 2011; 41: 221-295.
6. 6. Alm PA, Dreimanis K. Neuropathic pain: transcranial electric motor cortex stimulation using high frequency random noise. Case report of a novel treatment. J Pain Research 2013; 24: 6: 479-486.
7. 7. Klit H, Finnerup NB, Andersen G, Jensen TS. Central post stroke pain: a population-based study. Pain 2011; 152(4): 818-824.
8. 8. Hong E. Comparison of quality of life according to community walking in stroke patients. J Phys Ther Sci, 2015, 27: 2391–2393.

9. 9. Aprile I, Briani C, Pazzaglia C, Cecchi F, Negrini S, Padua L. Don Carlo Gnocchi Pain-Rehab Group.: Pain in stroke patients: characteristics and impact on the rehabilitation treatment. A multicenter cross-sectional study. Eur J Phys Rehabil Med, 2015; 51(6): 725-36.
10. 10. Hawker GA, Mian S, Kendzerska T, Melissa French. Measures of Adult Pain. Arthritis Care & Research 2011; 63: 11: 240–S252.
11. 11. Türkel Y, Türker H, Demir IA, Bayrak AO, Onar MK. Validation of self report version of the Leeds Assessment of Neuropathic Symptoms and Signs score for identification of neuropathic pain in patients from northern Turkey. Adv Clin Exp Med. 2014; 23(4): 599-603.
12. 12. Alkan H, Ardic F, Erdogan C, Sahin F, Sarsan A, Findikoglu G. Turkish version of the pain DETECT questionnaire in the assessment of neuropathic pain: a validity and reliability study. Pain Med. 2013 Dec;14(12):1933-43.
13. 13. Ilut S, Stan A, Blesneag A, Vacaras V, Vesa S, Fodoreanu L. Factors that influence the severity of post-stroke depression. J Med Life. 2017;10 (3): 167-171.
14. 14. Dąbrowska-Bender M, Milewska M, Gołąbek A, Duda-Zalewska A, Staniszewska A. The Impact of Ischemic Cerebral Stroke on the Quality of Life of Patients Based on Clinical, Social, and Psychoemotional Factors. J Stroke Cerebrovasc Dis. 2017; 26(1): 101–107.
15. 15. Harrison RA, Field TS. Post stroke pain: identification, assessment, and therapy. Cerebrovasc Dis. 2015; 39(3-4): 190-201.
16. 16. Koçyiğit H, Aydemir Ö, Fişek G, Ölmez N, Memiş A. The reliability and validity of Turkish version of Short form 36 (SF 36). J Drug Treat 1995, 12: 102–106.
17. 17. Klit H, Finnerup NB, Jensen TS. Central post-stroke pain: clinical characteristics, pathophysiology, and management. Lancet Neurol 2009; 8: 857–868.
18. 18. Fornasari D. Pharmacotherapy for Neuropathic Pain: A Review. Pain Ther. 2017; 6(1): 25-33.
19. 19. de Andrade DC, Mhalla A, Adam F, Texeira MJ, Bouhassira D. Neuropharmacological basis of rTMS- induced analgesia: The role of endogenous opioids. Pain 2011; 152: 320-326.
20. 20. Mylius V, Reis J, Knaack A, Haag A, Oertel WH, Rosenow F et al. High-frequency rTMS of the motor cortex does not influence the nociceptive flexion reflex but increases the unpleasantness of electrically induced pain. Neurosci Lett 2007; 415:49-54.
21. 21. Nahmias F, Debes C, Ciampi de Andrade D, Mhalla A, Bouhassira D. Diffuse analgesic effects of unilateral repetitive transcranial magnetic stimulation (rTMS) in healthy volunteers. Pain 2009; 147: 224-232.
22. 22. Valmunen T, Pertovaara A, Taiminen T, Virtanen A, Parkkola R, Sääskeläinena SK. Modulation of facial sensitivity by navigated rTMS in healthy subjects. Pain 2009; 142: 149-158.
23. 23. Garc ́ıa-Larrea L, Peyron R, Mertens P, Gregoire MC, Lavenne F, Le Bars D et al. Electrical stimulation of motor cortex for pain control: a combined PET-scan and electrophysiological study. Pain 1999; 83: 259-273.
24. 24. Peyron R, Garcia-Larrea L, Deiber MP, Deiber MP, Cinotti L, Convers P et al. Electrical stimulation of precentral cortical area in the treatment of central pain: electrophysiological and PET study. Pain 1995; 62(3): 275–286.
25. 25. Lamusuo S, Hirvonen J, Lindholm P, Martikainen IK, Hagelberg N, Parkkola R et al. Neurotransmitters behind pain relief with transcranial magnetic stimulation-positron emission tomography evidence for release of endogenous opioids. Eur J Pain. 2017; 21(9): 1505-1515.
26. 26. O’Connell NE, Wand BM, Marston L, Spencer S, DeSouza LH. Non-invasive brain stimulation for chronic pain. Cochrane Database Syst Rev. 2014; 11;(4): CD008208.
27. 27. O’Connell NE, Wand BM. Repetitive transcranial magnetic stimulation for chronic pain: Time to evolve from exploration to confirmation? Pain 2011; 152: 2451-2452.
28. 28. Hosomi K, Shimokawa T, Ikoma K, Nakamura Y, Sugiyama K, Ugawa Y et al. Daily repetitive transcranial magnetic stimulation of primary motor cortex for neuropathic pain: A randomized, multicenter, double-blind, crossover, sham-controlled trial. Pain 2013; 154:1065-1072.
29. 29. Short EB, Borckardt JJ, Anderson BS, Frohman H, Beam W, Reeves ST et al. Ten sessions of adjunctive left prefrontal rTMS significantly reduces fibromyalgia pain: A randomized, controlled pilot study. Pain 2011; 152: 2477-2484.
30. 30. Flaster M, Meresh E, Rao M, Biller J. Central poststroke pain: current diagnosis and treatment. Topics in stroke rehabilitation. 2013; 20(2): 116–123.
31. 31. Terao Y, Ugawa Y. Basic mechanisms of TMS. J Clin Neurophysiol. 2002; 19(4): 322-343.