Current Issue - November/December 2015 - Vol 18 Issue 6
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Abstract
PDF- 2015;18;E1029-E1046High Frequency Repetitive Transcranial Magnetic Stimulation Therapy For Chronic Neuropathic Pain: A Meta-analysis
Meta-Analysis
Qiwen Mu, MD, PhD, Morgan A. McClure, MS, Zhiwel Guo, MS, Xiang Liao, MS, Qing Tang, MS, Shenggang Feng, PhD, Anguo Wang, MS, Yu Jin, MS, Guoqiang Xing, PhD, and Guangming Li, PhD.
BACKGROUND: Increasing evidence supports an analgesic effect of repetitive transcranial magnetic stimulation (rTMS) for neuropathic pain (NP). However, the optimal parameters of rTMS (stimulation frequency and treatment sessions) for achieving long-term analgesic effects remain unknown. This study analyzed the current findings in the literature.
OBJECTIVE: The aim of this study was to assess the optimal parameters of rTMS for NP, including the rTMS sessions needed for inducing acute as well as long-term analgesic effects.
STUDY DESIGN: A meta-analysis of the analgesic effect of high frequency rTMS (HF- rTMS) for neuropathic patients.
SETTING: This meta-analysis examined all studies involving the analgesic efficacy of HF-rTMS for NP.
METHODS: PubMed, Embase, and the Cochrane library were searched for clinical studies of rTMS treatment on NP published before December 31, 2014. Crude standardized mean differences (SMD) with 95% confidence interval (CI) were calculated for pain intensity after different treatment sessions (from 1 to 10) and follow-up of one or 2 months after rTMS treatment using random effect models.
RESULTS: Twenty-five studies (including 32 trials and 589 patients) were selected for the meta-analysis according to the inclusion and exclusion criteria. All 3 HF-rTMS treatments (5, 10, and 20 Hz) produced pain reduction, while there were no differences between them, with the maximal pain reduction found after one and 5 sessions of rTMS treatment. Further, this significant analgesic effect remained forone month after 5 sessions of rTMS treatment.
LIMITATIONS: There are limitations of this meta-analysis. For example, the long-term analgesic effects of different HF-rTMS and low frequency (LF) rTMS sessions, including the single session of rTMS on different NP of varying origins have yet not been evaluated; the full degree of pain relief is still unclear for many rTMS studies.
CONCLUSIONS: HF-rTMS stimulation on primary motor cortex is effective in relieving pain in NP patients. Although 5 sessions of rTMS treatment produced a maximal analgesic effect and may be maintained for at least one month, further large-scale and well-controlled trials are needed to determine if this enhanced effect is specific to certain types of NP such as post-stroke related central NP.