rTMS is a treatment for persistent neuropathic pain prescribed with global patient approach. Do anyone use this method and with wich protocol? Do you use neuronavigation to localise the motor-cortex?
Best Regards
No, I don´t use rTMS for neuropathic pain. But you can ask Berthold Langguth (Psychiatrist, University of Regensburg) who has huge experiences with neuronavigated rTMS in Tinnitus.
In our protocol, we place the coil on the motor cortex of the hand (controlatéral) regardless of the pain location.
Would you please read my paper. :
Comparison Between Pharmacologic Evaluation and Repetitive Transcranial Magnetic Stimulation-Induced Analgesia in Poststroke Pain Patients.
Yuhei Matsumura
Teruyasu Hirayama
Takamitsu Yamamoto
Department of Neurological Surgery, Nihon University School of Dentistry at Matsudo, Chiba, Japan.
Neuromodulation (Impact Factor: 1.79). 01/2013; DOI: 10.1111/ner.12019
Source: PubMed
Edit
ABSTRACT BACKGROUND: It has been reported that poststroke pain has a complex pharmacologic background and that only about one-half of poststroke pain patients are sensitive to motor cortex stimulation induced by repetitive transcranial magnetic stimulation (rTMS). OBJECTIVES: The relationship between pharmacologic background and effects of rTMS of the primary motor cortex was investigated to clarify the pharmacologic basis of rTMS-induced analgesia in poststroke pain patients. METHODS: Changes in visual analog scale (VAS) score for pain following drug challenge tests using ketamine, morphine, and thiopental were compared with the changes in VAS score following rTMS of the primary motor cortex (frequency 5 Hz, at 100% resting motor threshold, 500 pulses per session) in 20 poststroke pain patients. RESULTS: In our drug challenge test, 10 of 20 (50%) patients in ketamine test, 7 of 20 (35%) in thiopental test, and 3 of 20 (15%) in morphine test showed more than 40% reduction of VAS score. VAS score decreased immediately after rTMS of motor cortex and persisted for 300 min (p < 0.05, Bonferroni's multiple comparisons). Comparison of the magnitude of VAS score reduction between drug challenge test and rTMS showed significant correlations with ketamine test (r = 0.503, p = 0.012), morphine test (r = 0.526, p = 0.009), and thiopental test (r = 0.609, p = 0.002) by regression analysis. CONCLUSIONS: rTMS-induced VAS score reduction correlated well with morphine, ketamine, and thiopental tests. However, ketamine sensitivity was observed in more cases compared with morphine and thiopental in poststroke pain patients. We speculate that additional pharmacologic therapy using ketamine as determined on the basis of the ketamine test may be useful for enhancing the efficacy of rTMS in poststroke pain patients.
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Very interresting paper
As Dr. Hirayama suggests ketamine enhance the efficacy of rTMS.
I have another idea: does ketamine test could be predictive of a good response to rTMS?
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