Five days of rTMS associated with motor imagery can decrease durably central neuropathic pain: Results from a cohort of 47 patients

Abstract

Neuropathic pain is frequent and often drug resistant, with an important impact on quality of life and function recovery. The aim of this study was to assess the efficacy of high frequency rTMS on motor cortex associated with motor imagery in patients with neuropathic pain. Between December 2014 and April 2017, 47 patients with central neuropathic pain were included. We studied clinical parameters (age, gender, pathology, pain duration and pain location) as well as cortical excitability. Before the treatment, a DN4 score and a BPI score were realized. Those two scores were repeated 48 hours after the treatment, at the beginning and at the end of 5 days of treatment, and during the follow up (at M1, M3 and M6). The treatment consisted in daily rTMS session, during five days, associated with motor imagery and mirror therapy. The primary outcome was a decreasing of the most intense pain of two points, defining responders. Thirty-four men and 13 women, 56,5 years old mean, with neuropathic pain from 6.6 years on average, principally secondary to stroke ( n = 24) were included. Thirty percent of patients were responders at 48 hours, M1 and M3, and this diminution of pain was significant (all P < 0.05). There was a significant association between responders at 48 hours and responders at M1 and M3, as well as between pain duration and non-responders at M3 (< 0.03). This study shows that high frequency TMS on the motor cortex associated with motor imagery can decrease neuropathic pain, as it is describes in literature, but durably with an effect until 3 months in our study. Furthermore, it may exist a link between responders at 48 hours and responders in the long term.