H-coil repetitive transcranial magnetic stimulation for pain relief in patients with diabetic neuropathy

  • E. O
  • M. G
  • C. C
 et al. 
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Background: Painful neuropathy is associated with plasticity changes in the nervous system. Standard repetitive transcranial magnetic stimulation (rTMS) is a non-invasive technique used to study changes in cortical excitability and to inhibit pain perception. Deep rTMS is a newer development that allows direct activation of deeper neuronal populations, by a unique coil design termed the H-coil. This study was designed to assess whether deep rTMS applied over the motor cortical lower-limb representation relieves pain in patients with diabetic neuropathy. Methods: Patients were randomly assigned to receive daily real or sham H-coil rTMS for 5 consecutive days. After a 5-week washout period, they crossed over to the alternative treatment for additional 5 days (according to a crossover study design). Outcome measures were changes in the visual analogue scale (VAS) for pain and in area and threshold of RIII nociceptive flexion reflex (RIII reflex). Results: Of the 25 patients randomized, 23 completed the study. After real rTMS, the VAS scores decreased significantly (p = 0.01), and so did RIII reflex area (p < 0.01), while no significant effects in these variables were induced by the sham rTMS treatment. The rTMS-induced changes in the outcome measures disappeared about 3 weeks after stimulation. All patients tolerated stimulation well. Conclusions: Deep H-coil rTMS provides pain relief in patients with diabetic neuropathy. This innovative technique can induce a therapeutic effect on brain areas that otherwise remain difficult to target. rTMS may produce its analgesic effects, inducing motor cortex plasticity and activating descending inhibitory pain control systems. © 2013 European Federation of International Association for the Study of Pain Chapters.

Author-supplied keywords

  • Beck Depression Inventory
  • Magstim Rapid
  • McGill Pain Questionnaire
  • action potential
  • aged
  • amitriptyline
  • analgesia
  • article
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  • clinical assessment
  • controlled study
  • crossover procedure
  • diabetic neuropathy
  • double blind procedure
  • duloxetine
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  • female
  • flexor reflex
  • gabapentin
  • human
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  • male
  • motor cortex
  • motor nerve conduction
  • nerve stimulator
  • neuropathic pain
  • outcome assessment
  • oxycodone
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  • placebo
  • pregabalin
  • priority journal
  • randomized controlled trial
  • repeat procedure
  • sham procedure
  • skin biopsy
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  • tramadol
  • transcranial magnetic stimulation
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  • venlafaxine
  • visual analog scale

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  • Onesti E.

  • Gabriele M.

  • Cambieri C.

  • Ceccanti M.

  • Raccah R.

  • Di Stefano G.

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