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The following is a summary of “Effects of multiple transcranial magnetic stimulation sessions on pain relief in patients with chronic neuropathic pain: A French cohort study in real-world clinical practice,” published in the December 2024 issue of Pain by Thomas et al.
Repetitive transcranial magnetic stimulation (rTMS) has shown effectiveness in reducing drug-resistant neuropathic pain (NP), but studies on its long-term feasibility and clinical efficacy in large real-world cohorts are lacking.
Researchers conducted a retrospective study analyzing 12 years of clinical data to evaluate the long-term analgesic effects of 20 Hz rTMS over the primary motor cortex in patients with NP, including subgroup analyses to identify predictive factors and explore the potential role of epidural motor cortex stimulation (eMCS).
They analyzed data from 213 patients who received iterative rTMS sessions as part of maintenance therapy for NP at the neurology and pain department of the University Hospital of Saint-Etienne between October 2010 and March 2022, of these, 25 patients had also undergone eMCS, with outcome data extracted from the neurosurgery department of the same hospital between October 2010 and June 2023.
The results showed 193 patients completed 4 rTMS sessions, with 42% reporting pain relief (PR) greater than 30% and improvement in the most disabling symptom. Analgesic effects of iterative rTMS sessions were maintained for up to 10 years in certain responders (≥10% PR) without adverse effects. The probability of success was higher in patients with central NP compared to peripheral NP (OR = 2.03 [1.04; 4.00]), and among those with central post-stroke pain, success was more likely in ischemic strokes compared to hemorrhagic strokes (OR = 3.36 [1.17; 10.05]), PR from iterative rTMS was an excellent predictor of eMCS efficacy.
Investigators concluded the rTMS efficacy in drug-resistant NP varies, emphasizing the need for patient selection and considering eMCS as a potential long-term solution for responders.
Source: onlinelibrary.wiley.com/doi/full/10.1002/ejp.4763
