H‐coil repetitive transcranial magnetic stimulation for pain relief in patients with diabetic neuropathy. (29th April 2013)

• Record Type: Journal Article
• Authors: Onesti, E.; Gabriele, M.; Cambieri, C.; Ceccanti, M.; Raccah, R.; Di Stefano, G.; Biasiotta, A.; Truini, A.; Zangen, A.; Inghilleri, M.
• Is Part Of: European journal of pain. Volume 17:Number 9(2013)
• Page Start: 1347
• Page End: 1356
• Publication Date: 2013-04-29
• Subjects: Pain -- Periodicals; Pain -- Treatment -- Periodicals; Pain -- Physiological aspects -- Periodicals; 616.0472
• DOI: 10.1002/j.1532-2149.2013.00320.x
• Languages: English
• ISSNs: 1090-3801

Abstract

Abstract: Background: Painful neuropathy is associated with plasticity changes in the nervous system. Standard repetitive transcranial magnetic stimulation (rTMS) is a non‐invasive technique used to study changes in cortical excitability and to inhibit pain perception. Deep rTMS is a newer development that allows direct activation of deeper neuronal populations, by a unique coil design termed the H‐coil. This study was designed to assess whether deep rTMS applied over the motor cortical lower‐limb representation relieves pain in patients with diabetic neuropathy. Methods: Patients were randomly assigned to receive daily real or sham H‐coil rTMS for 5 consecutive days. After a 5‐week washout period, they crossed over to the alternative treatment for additional 5 days (according to a crossover study design). Outcome measures were changes in the visual analogue scale (VAS) for pain and in area and threshold of RIII nociceptive flexion reflex (RIII reflex). Results: Of the 25 patients randomized, 23 completed the study. After real rTMS, the VAS scores decreased significantly ( p = 0.01), and so did RIII reflex area ( p < 0.01), while no significant effects in these variables were induced by the sham rTMS treatment. The rTMS‐induced changes in the outcome measures disappeared about 3 weeks after stimulation. All patients tolerated stimulation well. Conclusions: Deep H‐coil rTMS provides pain relief in patients with diabetic neuropathy. This innovative technique can induce a therapeutic effect on brain areas that otherwise remain difficult to target. rTMS may produce its analgesic effects, inducing motor cortex plasticity and activating descending inhibitory pain control systems.