Application of Repetitive Transcranial Magnetic Stimulation in Neuropathic Pain: A Narrative Review

Life, 2023 · DOI: 10.3390/life13020258 · Published: January 17, 2023

Simple Explanation

Neuropathic pain, which affects a significant portion of the population, can negatively impact quality of life and lead to functional impairment. rTMS is a non-invasive technique being explored for treating this type of pain. rTMS uses magnetic fields to induce electrical currents in the brain, modulating excitability. High-frequency rTMS generally excites while low-frequency rTMS inhibits brain activity. The review explores rTMS treatment protocols and adverse effects from clinical trials. Current evidence suggests that 10 Hz HF-rTMS of the primary motor cortex can reduce neuropathic pain, particularly in spinal cord injury, diabetic neuropathy, and post-herpetic neuralgia patients. However, a lack of standardized protocols limits the widespread use of rTMS.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Level 5, Narrative Review

Key Findings

1
Current evidence supports the use of 10 Hz HF-rTMS of the primary motor cortex to reduce neuropathic pain.
2
The analgesic effects of rTMS have been inconsistent with respect to different settings/parameters, causing insufficient evidence to determine its efficacy in patients with neuropathic pain.
3
The lack of standardized protocols impedes the universal use of rTMS for neuropathic pain.

Research Summary

This review provides an up-to-date overview of rTMS for treating neuropathic pain, summarizing treatment protocols and adverse effects from existing clinical trials. Current evidence suggests that 10 Hz HF-rTMS of the primary motor cortex can reduce neuropathic pain, especially in patients with spinal cord injury, diabetic neuropathy and post-herpetic neuralgia. rTMS is hypothesized to achieve analgesic effects by upregulating the pain threshold, inhibiting pain impulse, modulating the brain cortex, altering imbalanced functional connectivity, regulating neurotrophin and increasing endogenous opioid and anti-inflammatory cytokines.

Practical Implications

Clinical Practice

The review suggests a potential initial setting for rTMS treatment of neuropathic pain, which is 10 Hz HF-rTMS of the primary motor cortex.

Future Research

Further studies are needed to explore differences in parameters/settings of rTMS for treating neuropathic pain due to different diseases.

Protocol Standardization

The lack of standardized protocols impedes the universal use of rTMS in neuropathic pain.

Study Limitations

1
Some studies may have been inevitably omitted despite the systematic literature search.
2
Given the small number of included studies in each etiology category, difficulties arose in pointing out solid and strong opinions without too much bias.
3
The algorithm of rTMS application was not tailored according to different diseases.

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