Treatment of central neuropathic pain by rTMS and imagined movement

Abstract

Central neuropathic pain are frequent and often drug resistant, with an important impact on life quality and functional recovery. The aim of this study was to assess repetitive transcranial magnetic stimulation (rTMS) efficacy associated with imagined movement among patients with central neuropathic pain (CNP). Between December 2014 and August 2016, 39 patients with CNP were included. Exclusion criteria were contraindication to rTMS. We analyzed age, gender, diseases and pain duration. A DN4 score (defining the CNP) and a BPI score (assessing pain and impact of pain on life activities) were realized at day 0, 48 hours after a first rTMS stimulation, at the beginning and at the end of 5 days of rTMS stimulation, and at one month (M1), three months (M3) and six months (M6). A first rTMS stimulation was realized at day 0, and each a day during 5 days, associated with imagined movement. The primary outcome was a decreasing of the most intense pain of 2 points, defining responders. Twenty-six men and 13 women, 56.5 years old, with CNP from 7.5 years on average, were included. Seventeen had a stroke, 16 were spinal cord injury, and 6 had another central neuropathic disease. Twelve patients completed the whole study. There were 30.6% responders at 48 hours, 35.5% at M1, 32% at M3 and 25% at M6. There was a significant association between responders at 48 hours and responders at M1 and M3, as well as between pain duration and responders at M3. This study shows that rTMS associated with imagined movement is successful to decrease CNP, as it is described in literature, but with an effect until 6 months in our study. Furthermore, it may exist a link between responders at 48 hours and responders in the long term, as well as between pain duration and responders at M3.