Weekly Non-invasive Brain Stimulation Provides Relief of Post-stroke Pain

Weekly sessions of non-invasive repetitive transcranial magnetic stimulation (rTMS) provided sufficient long-term pain relief in 61 percent of patients with central post-stroke pain, and delivered long-term relief for patients who continued for one year, according to a study presented at the International Neuromodulation Society 12th World Congress. All patients received rTMS to their primary motor cortex once a week for at least 12 weeks. Of 18 patients in the open-label series, 11 patients achieved satisfactory-to-excellent pain relief, and pain relief was sustained in six patients who continued treatment for one year. Overall, eight patients who had severe stroke-caused dysesthesias experienced less relief than patients without severe dysesthesias, suggesting possible neural circuit damage was inhibiting response to treatment. The study participants had all been treated medically after a unilateral ischemic or hemorrhagic stroke. Several weeks into their recovery, they had begun to experience severe hand or leg pain as a consequence of brain damage from the stroke. A first phase of the study assessed whether rTMS had a treatment effect on pain. In it, the research team randomly assigned six patients to receive either sham or active rTMS one week and the other treatment the next, measuring pain scores before and after each session. Once that phase had shown that rTMS did reduce the patients’ pain, an open-label treatment phase began. In this second phase, the 18 patients underwent 12 weekly rTMS sessions, and the patients’ pain scores were measured just before each weekly session. Data were collected for eight years. The study builds on observations that electrical motor cortex stimulation’s effectiveness in relieving central post-stroke pain can be predicted by rTMS, suggesting the techniques share similar pain-relief mechanisms. However, the researchers acknowledge there has still been controversy about the efficacy of rTMS in post-stroke pain. To learn more about this study, click here.