OBJECTIVE: To assess, using a double-blind procedure, the pain-relieving effects of rTMS against placebo, and their predictive value regarding the efficacy of implanted motor cortex stimulation (MCS). METHODS: Three randomised, double-blinded, 25 min sessions of focal rTMS (1 Hz, 20 Hz and sham) were performed in 12 patients, at 2 weeks intervals. Effects on pain were estimated from daily scores across 5 days before, and 6 days after each session. Analgesic effects were correlated with those of subsequent implanted motor cortex stimulation (MCS). RESULTS: Immediately after the stimulating session, pain scores were similarly decreased by all rTMS modalities. Conversely, during the following week, 1 Hz stimulation provided significantly less analgesia than 20 Hz and placebo, and was pro-algesic in some patients. Placebo and 20 Hz rTMS were effective on different patients, and only 20 Hz rTMS predicted the efficacy of subsequent MCS, with no false positives. CONCLUSIONS: While 1Hz rTMS should not be used with analgesic purposes, high-frequency rTMS may become useful to select candidates for MCS. Placebo effects are powerful and should be controlled for. Immediate results after a single rTMS session are misleading. SIGNIFICANCE: Defining rTMS parameters is a crucial step before proposing rTMS as predictive test of SCM efficacy in clinical practice.
RCT Entities:
OBJECTIVE: To assess, using a double-blind procedure, the pain-relieving effects of rTMS against placebo, and their predictive value regarding the efficacy of implanted motor cortex stimulation (MCS). METHODS: Three randomised, double-blinded, 25 min sessions of focal rTMS (1 Hz, 20 Hz and sham) were performed in 12 patients, at 2 weeks intervals. Effects on pain were estimated from daily scores across 5 days before, and 6 days after each session. Analgesic effects were correlated with those of subsequent implanted motor cortex stimulation (MCS). RESULTS: Immediately after the stimulating session, pain scores were similarly decreased by all rTMS modalities. Conversely, during the following week, 1 Hz stimulation provided significantly less analgesia than 20 Hz and placebo, and was pro-algesic in some patients. Placebo and 20 Hz rTMS were effective on different patients, and only 20 Hz rTMS predicted the efficacy of subsequent MCS, with no false positives. CONCLUSIONS: While 1Hz rTMS should not be used with analgesic purposes, high-frequency rTMS may become useful to select candidates for MCS. Placebo effects are powerful and should be controlled for. Immediate results after a single rTMS session are misleading. SIGNIFICANCE: Defining rTMS parameters is a crucial step before proposing rTMS as predictive test of SCM efficacy in clinical practice.
Authors: Jeffrey J Borckardt; Scott T Reeves; Heather Frohman; Alok Madan; Mark P Jensen; David Patterson; Kelly Barth; A Richard Smith; Richard Gracely; Mark S George Journal: Pain Date: 2010-11-30 Impact factor: 6.961
Authors: Satish Mistry; Eric Verin; Salil Singh; Samantha Jefferson; John C Rothwell; David G Thompson; Shaheen Hamdy Journal: J Physiol Date: 2007-10-11 Impact factor: 5.182