Difference in Analgesic Effects of Repetitive Transcranial Magnetic Stimulation According to the Site of Pain

High-frequency repetitive transcranial magnetic stimulation (rTMS) of the primary motor cortex for neuropathic pain has been shown to be effective, according to systematic reviews and therapeutic guidelines. However, our large, rigorous, investigator-initiated, registration-directed clinical trial f...

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Autores principales:	Nobuhiko Mori, Koichi Hosomi, Asaya Nishi, Dong Dong, Takufumi Yanagisawa, Hui Ming Khoo, Naoki Tani, Satoru Oshino, Youichi Saitoh, Haruhiko Kishima
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	repetitive transcranial magnetic stimulation (rTMS) motor cortex stimulation neuropathic pain meta-analysis pain sites upper limb Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571
Acceso en línea:	https://doaj.org/article/032eb2570cb54a67a512173a2f9a5c43
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spelling	oai:doaj.org-article:032eb2570cb54a67a512173a2f9a5c432021-12-01T07:34:26ZDifference in Analgesic Effects of Repetitive Transcranial Magnetic Stimulation According to the Site of Pain1662-516110.3389/fnhum.2021.786225https://doaj.org/article/032eb2570cb54a67a512173a2f9a5c432021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fnhum.2021.786225/fullhttps://doaj.org/toc/1662-5161High-frequency repetitive transcranial magnetic stimulation (rTMS) of the primary motor cortex for neuropathic pain has been shown to be effective, according to systematic reviews and therapeutic guidelines. However, our large, rigorous, investigator-initiated, registration-directed clinical trial failed to show a positive primary outcome, and its subgroup analysis suggested that the analgesic effect varied according to the site of pain. The aim of this study was to investigate the differences in analgesic effects of rTMS for neuropathic pain between different pain sites by reviewing our previous clinical trials. We included three clinical trials in this mini meta-analysis: a multicenter randomized controlled trial at seven hospitals (N = 64), an investigator-initiated registration-directed clinical trial at three hospitals (N = 142), and an exploratory clinical trial examining different stimulation parameters (N = 22). The primary efficacy endpoint (change in pain scale) was extracted for each patient group with pain in the face, upper limb, or lower limb, and a meta-analysis of the efficacy of active rTMS against sham stimulation was performed. Standardized mean difference (SMD) with 95% confidence interval (CI) was calculated for pain change using a random-effects model. The analgesic effect of rTMS for upper limb pain was favorable (SMD = −0.45, 95% CI: −0.77 to −0.13). In contrast, rTMS did not produce significant pain relief on lower limb pain (SMD = 0.04, 95% CI: −0.33 to 0.41) or face (SMD = −0.24, 95% CI: −1.59 to 1.12). In conclusion, these findings suggest that rTMS provides analgesic effects in patients with neuropathic pain in the upper limb, but not in the lower limb or face, under the conditions of previous clinical trials. Owing to the main limitation of small number of studies included, many aspects should be clarified by further research and high-quality studies in these patients.Nobuhiko MoriKoichi HosomiAsaya NishiDong DongTakufumi YanagisawaTakufumi YanagisawaHui Ming KhooNaoki TaniSatoru OshinoYouichi SaitohYouichi SaitohHaruhiko KishimaFrontiers Media S.A.articlerepetitive transcranial magnetic stimulation (rTMS)motor cortex stimulationneuropathic painmeta-analysispain sitesupper limbNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571ENFrontiers in Human Neuroscience, Vol 15 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	repetitive transcranial magnetic stimulation (rTMS) motor cortex stimulation neuropathic pain meta-analysis pain sites upper limb Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571
spellingShingle	repetitive transcranial magnetic stimulation (rTMS) motor cortex stimulation neuropathic pain meta-analysis pain sites upper limb Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Nobuhiko Mori Koichi Hosomi Asaya Nishi Dong Dong Takufumi Yanagisawa Takufumi Yanagisawa Hui Ming Khoo Naoki Tani Satoru Oshino Youichi Saitoh Youichi Saitoh Haruhiko Kishima Difference in Analgesic Effects of Repetitive Transcranial Magnetic Stimulation According to the Site of Pain
description	High-frequency repetitive transcranial magnetic stimulation (rTMS) of the primary motor cortex for neuropathic pain has been shown to be effective, according to systematic reviews and therapeutic guidelines. However, our large, rigorous, investigator-initiated, registration-directed clinical trial failed to show a positive primary outcome, and its subgroup analysis suggested that the analgesic effect varied according to the site of pain. The aim of this study was to investigate the differences in analgesic effects of rTMS for neuropathic pain between different pain sites by reviewing our previous clinical trials. We included three clinical trials in this mini meta-analysis: a multicenter randomized controlled trial at seven hospitals (N = 64), an investigator-initiated registration-directed clinical trial at three hospitals (N = 142), and an exploratory clinical trial examining different stimulation parameters (N = 22). The primary efficacy endpoint (change in pain scale) was extracted for each patient group with pain in the face, upper limb, or lower limb, and a meta-analysis of the efficacy of active rTMS against sham stimulation was performed. Standardized mean difference (SMD) with 95% confidence interval (CI) was calculated for pain change using a random-effects model. The analgesic effect of rTMS for upper limb pain was favorable (SMD = −0.45, 95% CI: −0.77 to −0.13). In contrast, rTMS did not produce significant pain relief on lower limb pain (SMD = 0.04, 95% CI: −0.33 to 0.41) or face (SMD = −0.24, 95% CI: −1.59 to 1.12). In conclusion, these findings suggest that rTMS provides analgesic effects in patients with neuropathic pain in the upper limb, but not in the lower limb or face, under the conditions of previous clinical trials. Owing to the main limitation of small number of studies included, many aspects should be clarified by further research and high-quality studies in these patients.
format	article
author	Nobuhiko Mori Koichi Hosomi Asaya Nishi Dong Dong Takufumi Yanagisawa Takufumi Yanagisawa Hui Ming Khoo Naoki Tani Satoru Oshino Youichi Saitoh Youichi Saitoh Haruhiko Kishima
author_facet	Nobuhiko Mori Koichi Hosomi Asaya Nishi Dong Dong Takufumi Yanagisawa Takufumi Yanagisawa Hui Ming Khoo Naoki Tani Satoru Oshino Youichi Saitoh Youichi Saitoh Haruhiko Kishima
author_sort	Nobuhiko Mori
title	Difference in Analgesic Effects of Repetitive Transcranial Magnetic Stimulation According to the Site of Pain
title_short	Difference in Analgesic Effects of Repetitive Transcranial Magnetic Stimulation According to the Site of Pain
title_full	Difference in Analgesic Effects of Repetitive Transcranial Magnetic Stimulation According to the Site of Pain
title_fullStr	Difference in Analgesic Effects of Repetitive Transcranial Magnetic Stimulation According to the Site of Pain
title_full_unstemmed	Difference in Analgesic Effects of Repetitive Transcranial Magnetic Stimulation According to the Site of Pain
title_sort	difference in analgesic effects of repetitive transcranial magnetic stimulation according to the site of pain
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/032eb2570cb54a67a512173a2f9a5c43
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Difference in Analgesic Effects of Repetitive Transcranial Magnetic Stimulation According to the Site of Pain

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