Continuous repetitive transcranial magnetic stimulation for intractable neuropathic pain
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Dec 7, 2012. Continuous Repetitive Transcranial Magnetic Stimulation for intractable Neuropathic Pain. Youichi Saitoh , M.D., Ph.D. Department of Neuromodulation and Neurosurgery Office for Univeristy -Industry Collaboration, Osaka University.

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Continuous Repetitive Transcranial Magnetic Stimulation for intractable Neuropathic Pain

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Dec 7, 2012

Continuous Repetitive Transcranial Magnetic Stimulation for intractable Neuropathic Pain

YouichiSaitoh, M.D., Ph.D.

Department of Neuromodulation and Neurosurgery

Office for Univeristy-Industry Collaboration,

Osaka University

Electrical motor cortex stimulation; EMCS

EMCS expand to the world from Japan

Rasche et al., Pain, 2006

Saitoh et al. J Neurosurg 2000

Department of Neurosurgery, Osaka University Graduate School of Medicine

Efficacy of EMCS on intractable neuropathic pain

Approximately half of the patients satisfy

No large double-blinded clinical trials

Saitoh and Yoshimine, ActaNeurochirSuppl, 2007

Saitoh Y et al, ActaNeurochir, 2007

Repetitive transcranial magnetic stimulation(rTMS)

Eddy current


Figure-8-coil is most popular

Cochrane reviewO’Connell NE et al, 2010Non-invasive brain stimulation techniques for chronic pain

  • Single doses of high-frequency rTMS of motor cortex may have short-term effects on chronic pain.

  • Efficacies of cranial electrotherapy stimulation and transcranial direct current stimulation are uncertain.


Multi-centered, Randomized, double-blind, sham-controlled, crossover study2009 〜2011

This study was funded by the Japanese Ministry of Health,

Labourand Welfare with a Health and Labour Sciences Research Grant.

Randomized, double-blind, sham-controlled, crossover study

  • Real (5Hz)and sham stimulations are randomized.

    • Double-blind Randomized Crossover Study

    • Specialist of biological statistics randomized the patients to two groups.

  • Validation of efficacy and safety of daily rTMS for 2 weeks.

    • Previous studies were mostly single session

    • Primary endpoint is VAS, secondary is SF-MPQ

  • Realistic shamis applied.

    • Synchronized cutaneous electrical stimulation is delivered.

    • Hamada M et al, MovDisord, 23:1524-31, 2008

  • 70 patients

Randomized, double-blind, sham-controlled, crossover study

  • Seven centers

    • Rehabilitation, Hokaido Univ.

    • Neurology, Fukushima

    • Neurosurgery, Nihon Univ.

    • Neurosurgery, Hamamatsu Univ.

    • Neurosurgery, Osaka Univ.

    • Neurology, Kinki Univ.

    • Neurology, Univ. of Occulational

Protocol of sham-controlled crossover study

Trial profile

Sham first

Real first

Results of short-term effect of VASPrimary endpoint

Results of short-term effect ofSF-MPQ Secondary endpoint

Patient global impression of change (PGIC)


Beck depression inventory (BDI)


Forest Plot of subgroup analyses

Adverse effects


  • This prospective study shows daily high-frequency rTMS is transiently effective for pain relief in intractable neuropathic pain patients (70 cases).

  • There has been no serious adverse effects.

  • The real rTMS, compared with the sham, showed significant short-term improvements in VAS and SF-MPQ scores without a carry-over effect. The result of PGIC suggested cumulative effect.

  • More than once a day or continuous rTMS treatment may improve the effect.

  • In this study, 81% of enrolled patients were post-stroke pain and 60.7 y.o. (mean) which is older than previous studies. Therefore, the effect was mild but significant.

Cerebral mechanism of pain relief(EMCS, rTMS)





Modulate pain recognition




Pain relief


Modulate a pain threshold

Elicit plastic changes

Thank you for attention!!

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