Abstract
Introduction: Post-stroke thalamic pain is a serious problem for some patients after stroke, deteriorating their activities of daily life, and is often resistant to medical treatments. Surgical intervention, such as electrical motor cortex stimulation, has been reported to be effective, but only for 40-60% of the patients despite of invasive procedures and costly devices. For some patients with electrical motor cortex stimulation, continuous stimulation is not always essential while occasional stimulation, such as a few hours every several days, is enough for their pain control. Recently, repetitive transcranial magnetic stimulation (rTMS) is reported to relieve post-stroke pain transiently but effectively. Hypothesis: We assessed the hypothesis that rTMS of motor cortex, maintained once a week, could induce sustainable long-term pain relief in patients with medication-resistant post-stroke pain. Methods: Fifteen patients suffering from medication-resistant post-stroke pain after thalamic hemorrhagic stroke were included. rTMS (10 trains of 10-second 5Hz TMS pulses at 50-second intervals, 90% of active motor threshold) was delivered on the motor cortex of the affected side. The rTMS session was repeated once a week for more than 12 weeks. The effect of rTMS on pain was rated by patients using a visual analog scale (VAS). Result: Mean VAS (±SEM) before rTMS (baseline) was 6.4±0.4 and reduced gradually and significantly in accordance with rTMS sessions. The VAS 12 weeks later was 3.4±0.5. Nine of 15 patients (60%) reported reduction of three or more VAS points. Five patients suffering from paresthesia rather than pain showed less reduction of VAS compared to the others. In five patients, rTMS was continued for one year and the effect of pain relief was also sustained. Conclusion: rTMS of the motor cortex, when maintained once a week, can provide long-term pain relief in patients with medication-resistant post-stroke pain.
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