Repetitive Transcranial Magnetic Stimulation for Phantom Limb Pain in Land Mine Victims: A Double-Blinded, Randomized, Sham-Controlled Trial
We evaluated the effects of repetitive transcranial magnetic stimulation (rTMS) in the treatment of phantom limb pain (PLP) in land mine victims. Fifty-four patients with PLP were enrolled in a randomized, double-blinded, placebo-controlled, parallel group single-center trial. The intervention consi...
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| Veröffentlicht in: | The journal of pain 2016-08, Vol.17 (8), p.911-918 |
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| creator | Malavera, Alejandra Silva, Federico Arturo Fregni, Felipe Carrillo, Sandra Garcia, Ronald G. |
| description | We evaluated the effects of repetitive transcranial magnetic stimulation (rTMS) in the treatment of phantom limb pain (PLP) in land mine victims. Fifty-four patients with PLP were enrolled in a randomized, double-blinded, placebo-controlled, parallel group single-center trial. The intervention consisted of real or sham rTMS of M1 contralateral to the amputated leg. rTMS was given in series of 20 trains of 6-second duration (54-second intertrain, intensity 90% of motor threshold) at a stimulation rate of 10 Hz (1,200 pulses), 20 minutes per day, during 10 days. For the control group, a sham coil was used. The administration of active rTMS induced a significantly greater reduction in pain intensity (visual analogue scale scores) 15 days after treatment compared with sham stimulation (−53.38 ± 53.12% vs −22.93 ± 57.16%; mean between-group difference = 30.44%, 95% confidence interval, .30–60.58; P = .03). This effect was not significant 30 days after treatment. In addition, 19 subjects (70.3%) attained a clinically significant pain reduction (>30%) in the active group compared with 11 in the sham group (40.7%) 15 days after treatment (P = .03). The administration of 10 Hz rTMS on the contralateral primary motor cortex for 2 weeks in traumatic amputees with PLP induced significant clinical improvement in pain.
High-frequency rTMS on the contralateral primary motor cortex of traumatic amputees induced a clinically significant pain reduction up to 15 days after treatment without any major secondary effect. These results indicate that rTMS is a safe and effective therapy in patients with PLP caused by land mine explosions.
•Transcranial magnetic stimulation had a significant analgesic effect in phantom limb pain (PLP) patients.•Transcranial magnetic stimulation was well tolerated in land mine victims with PLP.•Noninvasive brain stimulation might be a promising option for PLP rehabilitation. |
| doi_str_mv | 10.1016/j.jpain.2016.05.003 |
| format | Article |
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High-frequency rTMS on the contralateral primary motor cortex of traumatic amputees induced a clinically significant pain reduction up to 15 days after treatment without any major secondary effect. These results indicate that rTMS is a safe and effective therapy in patients with PLP caused by land mine explosions.
•Transcranial magnetic stimulation had a significant analgesic effect in phantom limb pain (PLP) patients.•Transcranial magnetic stimulation was well tolerated in land mine victims with PLP.•Noninvasive brain stimulation might be a promising option for PLP rehabilitation.</description><identifier>ISSN: 1526-5900</identifier><identifier>EISSN: 1528-8447</identifier><identifier>DOI: 10.1016/j.jpain.2016.05.003</identifier><identifier>PMID: 27260638</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Anxiety - etiology ; Depression - etiology ; Disaster Victims - psychology ; Disaster Victims - rehabilitation ; Double-Blind Method ; Female ; Follow-Up Studies ; Humans ; land mine victims ; Male ; neuropathic pain ; noninvasive brain stimulation ; Phantom Limb - complications ; Phantom Limb - psychology ; Phantom Limb - rehabilitation ; Phantom limb pain ; rTMS ; Time Factors ; Transcranial Magnetic Stimulation - methods</subject><ispartof>The journal of pain, 2016-08, Vol.17 (8), p.911-918</ispartof><rights>2016 American Pain Society</rights><rights>Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c470t-ecaf60f1ffe7215f448adcb8f8f22c0c3ac5e7c91d972230c71bcbaa26efe93c3</citedby><cites>FETCH-LOGICAL-c470t-ecaf60f1ffe7215f448adcb8f8f22c0c3ac5e7c91d972230c71bcbaa26efe93c3</cites><orcidid>0000-0002-8117-1367</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1526590016300645$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27260638$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Malavera, Alejandra</creatorcontrib><creatorcontrib>Silva, Federico Arturo</creatorcontrib><creatorcontrib>Fregni, Felipe</creatorcontrib><creatorcontrib>Carrillo, Sandra</creatorcontrib><creatorcontrib>Garcia, Ronald G.</creatorcontrib><title>Repetitive Transcranial Magnetic Stimulation for Phantom Limb Pain in Land Mine Victims: A Double-Blinded, Randomized, Sham-Controlled Trial</title><title>The journal of pain</title><addtitle>J Pain</addtitle><description>We evaluated the effects of repetitive transcranial magnetic stimulation (rTMS) in the treatment of phantom limb pain (PLP) in land mine victims. Fifty-four patients with PLP were enrolled in a randomized, double-blinded, placebo-controlled, parallel group single-center trial. The intervention consisted of real or sham rTMS of M1 contralateral to the amputated leg. rTMS was given in series of 20 trains of 6-second duration (54-second intertrain, intensity 90% of motor threshold) at a stimulation rate of 10 Hz (1,200 pulses), 20 minutes per day, during 10 days. For the control group, a sham coil was used. The administration of active rTMS induced a significantly greater reduction in pain intensity (visual analogue scale scores) 15 days after treatment compared with sham stimulation (−53.38 ± 53.12% vs −22.93 ± 57.16%; mean between-group difference = 30.44%, 95% confidence interval, .30–60.58; P = .03). This effect was not significant 30 days after treatment. In addition, 19 subjects (70.3%) attained a clinically significant pain reduction (>30%) in the active group compared with 11 in the sham group (40.7%) 15 days after treatment (P = .03). The administration of 10 Hz rTMS on the contralateral primary motor cortex for 2 weeks in traumatic amputees with PLP induced significant clinical improvement in pain.
High-frequency rTMS on the contralateral primary motor cortex of traumatic amputees induced a clinically significant pain reduction up to 15 days after treatment without any major secondary effect. These results indicate that rTMS is a safe and effective therapy in patients with PLP caused by land mine explosions.
•Transcranial magnetic stimulation had a significant analgesic effect in phantom limb pain (PLP) patients.•Transcranial magnetic stimulation was well tolerated in land mine victims with PLP.•Noninvasive brain stimulation might be a promising option for PLP rehabilitation.</description><subject>Adult</subject><subject>Anxiety - etiology</subject><subject>Depression - etiology</subject><subject>Disaster Victims - psychology</subject><subject>Disaster Victims - rehabilitation</subject><subject>Double-Blind Method</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>land mine victims</subject><subject>Male</subject><subject>neuropathic pain</subject><subject>noninvasive brain stimulation</subject><subject>Phantom Limb - complications</subject><subject>Phantom Limb - psychology</subject><subject>Phantom Limb - rehabilitation</subject><subject>Phantom limb pain</subject><subject>rTMS</subject><subject>Time Factors</subject><subject>Transcranial Magnetic Stimulation - methods</subject><issn>1526-5900</issn><issn>1528-8447</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kV1vFCEUhonR2Fr9BSaGSy-cEZgPZk28qOtnso1NW70lzJmDZcPAFpgm-hv80bLd6qUJgUN43vMCLyHPOas54_3rbb3daetrUTY162rGmgfkmHdiqIa2lQ_v6r7qVowdkScpbRnjvJPyMTkSUvSsb4Zj8vsCd5httrdIr6L2CcpktaNn-ocvB0Avs50Xp7MNnpoQ6fm19jnMdGPnkZ6XC9AyNtpP9Mx6pN8tFEF6Q0_p-7CMDqt3zvoJp1f0okBhtr_29eW1nqt18DkG53Aq3sX0KXlktEv47H49Id8-frhaf642Xz99WZ9uKmglyxWCNj0z3BiUgnembQc9wTiYwQgBDBoNHUpY8WklhWgYSD7CqLXo0eCqgeaEvDz03cVws2DKarYJ0DntMSxJ8YENjeyEbAvaHFCIIaWIRu2inXX8qThT-xjUVt3FoPYxKNapEkNRvbg3WMYZp3-av_9egLcHAMszby1GlcCiB5xsRMhqCva_Bn8A_4acMQ</recordid><startdate>201608</startdate><enddate>201608</enddate><creator>Malavera, Alejandra</creator><creator>Silva, Federico Arturo</creator><creator>Fregni, Felipe</creator><creator>Carrillo, Sandra</creator><creator>Garcia, Ronald G.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8117-1367</orcidid></search><sort><creationdate>201608</creationdate><title>Repetitive Transcranial Magnetic Stimulation for Phantom Limb Pain in Land Mine Victims: A Double-Blinded, Randomized, Sham-Controlled Trial</title><author>Malavera, Alejandra ; Silva, Federico Arturo ; Fregni, Felipe ; Carrillo, Sandra ; Garcia, Ronald G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c470t-ecaf60f1ffe7215f448adcb8f8f22c0c3ac5e7c91d972230c71bcbaa26efe93c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Anxiety - etiology</topic><topic>Depression - etiology</topic><topic>Disaster Victims - psychology</topic><topic>Disaster Victims - rehabilitation</topic><topic>Double-Blind Method</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>land mine victims</topic><topic>Male</topic><topic>neuropathic pain</topic><topic>noninvasive brain stimulation</topic><topic>Phantom Limb - complications</topic><topic>Phantom Limb - psychology</topic><topic>Phantom Limb - rehabilitation</topic><topic>Phantom limb pain</topic><topic>rTMS</topic><topic>Time Factors</topic><topic>Transcranial Magnetic Stimulation - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Malavera, Alejandra</creatorcontrib><creatorcontrib>Silva, Federico Arturo</creatorcontrib><creatorcontrib>Fregni, Felipe</creatorcontrib><creatorcontrib>Carrillo, Sandra</creatorcontrib><creatorcontrib>Garcia, Ronald G.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The journal of pain</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Malavera, Alejandra</au><au>Silva, Federico Arturo</au><au>Fregni, Felipe</au><au>Carrillo, Sandra</au><au>Garcia, Ronald G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Repetitive Transcranial Magnetic Stimulation for Phantom Limb Pain in Land Mine Victims: A Double-Blinded, Randomized, Sham-Controlled Trial</atitle><jtitle>The journal of pain</jtitle><addtitle>J Pain</addtitle><date>2016-08</date><risdate>2016</risdate><volume>17</volume><issue>8</issue><spage>911</spage><epage>918</epage><pages>911-918</pages><issn>1526-5900</issn><eissn>1528-8447</eissn><abstract>We evaluated the effects of repetitive transcranial magnetic stimulation (rTMS) in the treatment of phantom limb pain (PLP) in land mine victims. Fifty-four patients with PLP were enrolled in a randomized, double-blinded, placebo-controlled, parallel group single-center trial. The intervention consisted of real or sham rTMS of M1 contralateral to the amputated leg. rTMS was given in series of 20 trains of 6-second duration (54-second intertrain, intensity 90% of motor threshold) at a stimulation rate of 10 Hz (1,200 pulses), 20 minutes per day, during 10 days. For the control group, a sham coil was used. The administration of active rTMS induced a significantly greater reduction in pain intensity (visual analogue scale scores) 15 days after treatment compared with sham stimulation (−53.38 ± 53.12% vs −22.93 ± 57.16%; mean between-group difference = 30.44%, 95% confidence interval, .30–60.58; P = .03). This effect was not significant 30 days after treatment. In addition, 19 subjects (70.3%) attained a clinically significant pain reduction (>30%) in the active group compared with 11 in the sham group (40.7%) 15 days after treatment (P = .03). The administration of 10 Hz rTMS on the contralateral primary motor cortex for 2 weeks in traumatic amputees with PLP induced significant clinical improvement in pain.
High-frequency rTMS on the contralateral primary motor cortex of traumatic amputees induced a clinically significant pain reduction up to 15 days after treatment without any major secondary effect. These results indicate that rTMS is a safe and effective therapy in patients with PLP caused by land mine explosions.
•Transcranial magnetic stimulation had a significant analgesic effect in phantom limb pain (PLP) patients.•Transcranial magnetic stimulation was well tolerated in land mine victims with PLP.•Noninvasive brain stimulation might be a promising option for PLP rehabilitation.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27260638</pmid><doi>10.1016/j.jpain.2016.05.003</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-8117-1367</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | The journal of pain, 2016-08, Vol.17 (8), p.911-918 |
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| subjects | Adult Anxiety - etiology Depression - etiology Disaster Victims - psychology Disaster Victims - rehabilitation Double-Blind Method Female Follow-Up Studies Humans land mine victims Male neuropathic pain noninvasive brain stimulation Phantom Limb - complications Phantom Limb - psychology Phantom Limb - rehabilitation Phantom limb pain rTMS Time Factors Transcranial Magnetic Stimulation - methods |
| title | Repetitive Transcranial Magnetic Stimulation for Phantom Limb Pain in Land Mine Victims: A Double-Blinded, Randomized, Sham-Controlled Trial |
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