From the Research
Transcranial magnetic stimulation (TMS) shows moderate efficacy for treating central post-stroke pain (CPSP), with repetitive TMS (rTMS) being the most promising approach. The most recent and highest quality study, published in 2023 1, suggests that high-frequency rTMS applied to the primary motor cortex contralateral to the painful side typically provides the best results.
Key Findings
- A standard protocol involves 10-20 daily sessions of rTMS at 10 Hz frequency, 80-90% of motor threshold intensity, with 1500-3000 pulses per session.
- Pain reduction typically ranges from 20-40% in responsive patients, with effects lasting from several days to weeks after a treatment course.
- Maintenance sessions may be required every 2-4 weeks to sustain benefits.
- TMS works by modulating neural activity in pain processing pathways, reducing hyperexcitability and restoring inhibitory mechanisms disrupted by stroke.
Considerations
- The treatment is generally safe with minimal side effects like headache or scalp discomfort.
- However, response rates vary significantly between patients, and TMS should be considered as part of a comprehensive pain management approach rather than a standalone treatment.
- Patients should be evaluated for contraindications such as seizure history, metal implants, or pregnancy before beginning treatment.
Additional Insights
- A case study published in 2021 2 reported the efficacy of rTMS for acute central post-stroke pain, highlighting the potential benefits of early intervention.
- Another study published in 2016 3 discussed the importance of considering the impact of anatomically disrupted neural tissues on the location, orientation, and magnitude of exogenously applied currents during neurostimulation treatments.