The Effects of Fast Left Prefrontal rTMS on Chronic Neuropathic Pain

Jeffrey J. Borckardt, PhD

Assistant Professor
Brain Stimulation Laboratory and Center for Advanced Imaging Research
Medical University of South Carolina
Charleston, South Carolina

Repetitive transcranial magnetic stimulation (rTMS), a minimally invasive brain stimulation technique, involves repeated magnetic field pulses that depolarize superficial neurons and stimulate the cortex. This technology has been studied for the treatment of psychiatric disorders as well as more recently for the management of pain. In the post-operative setting, patients who underwent a single session of prefrontal rTMS immediately following surgery show reduced morphine requirements. Furthermore, whereas most studies have focused on stimulating the motor cortex in patients with neuropathic pain, the left prefrontal cortex—an area thought to inhibit affective aspects of pain—appears to be promising cortical target for managing neuropathic pain syndromes. In a pilot study, three sessions of prefrontal stimulation resulted in 19% reductions in daily pain on average, pain at its worst, and pain at its least, effects that were maintained for approximately two weeks.

References

Borckardt JJ, Smith AR, Reeves ST, et al. A pilot study investigating the effects of fast left prefrontal rTMS on chronic neuropathic pain. Pain Med. 2009 Jul 6.
George MS, Nahas Z, Kozel FA, et al. Mechanisms and the current state of transcranial magnetic stimulation. CNS Spectr. 2003;8:496-514.
Borckardt JJ, Weinstein M, Reeves ST, et al. Postoperative left prefrontal repetitive transcranial magnetic stimulation reduces patient-controlled analgesia use. Anesthesiology. 2006;105:557-562.

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