The Value of High-Frequency Repetitive Transcranial Magnetic Stimulation of the Motor Cortex to Treat Central Pain Sensitization Associated With Knee Osteoarthritis.

Jean-Paul Nguyen,Julien Nizard,Catherine Malineau,Jean-Pascal Lefaucheur,Alcira Suarez Moreno,Véronique Dixneuf,Julien Esnaut

doi:10.3389/fnins.2019.00388

Abstract

AimChronic pain associated with knee osteoarthritis may develop in connection with a maladaptive process of pain sensitization in the central nervous system. Repetitive transcranial magnetic stimulation (rTMS) has been proposed to treat various pain syndromes related to central sensitization phenomenon, but was never applied in the context of knee osteoarthritis.MethodsA 71-year-old woman presenting clinical evidence of central sensitization of pain associated with left knee osteoarthritis underwent monthly sessions of rTMS delivered at 10 Hz over the right motor cortex.ResultsFrom the week following the third session, she began to improve on various clinical aspects, including pain. After 10 sessions (i.e., almost one year of follow-up), pain was reduced by 67%, especially regarding neuropathic components, while sleep disorders and fatigue also improved by 57–67%. The central sensitization inventory (CSI) score was reduced by 70%.ConclusionThis observation suggests that high-frequency motor cortex rTMS could be a therapeutic option to treat neuropathic pain and psychological symptoms associated with central sensitization developing in the context of chronic osteoarthritis of the knee joint.

Highlights

Pain is the main symptom of knee osteoarthritis (Nguyen et al, 2011)
We present the case of a woman suffering from chronic pain related to knee osteoarthritis and resistant to medical treatment
The stimulation parameters for one session were as follows: 20 trains of 70 repetitive transcranial magnetic stimulation (rTMS) pulses delivered at high frequency of 10 Hz, i.e., 1,400 pulses for a session lasting about 20 min

Summary

Introduction

Pain is the main symptom of knee osteoarthritis (Nguyen et al, 2011) It initially appears as “mechanical,” occurring when the joint is solicited, and gradually leads to joint stiffness, which can cause gait disorders and postural imbalance. In the medium or long term, the repetition of painful episodes may be at the origin of a phenomenon of sensitization to pain, which develops in the central nervous system In this case, pain extends beyond the joint and acquires neuropathic features (Lluch Girbés et al, 2016). Central sensitization is accompanied by exacerbated fatigue, alteration of sleep quality, and mood disorders (Murphy et al, 2011) At this stage, the pain syndrome can become resistant to medical treatment or surgical intervention (Skou et al, 2016) and other therapeutic approaches must be proposed

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