Comparing the impact of multi-session left dorsolateral prefrontal and primary motor cortex neuronavigated repetitive transcranial magnetic stimulation (nrTMS) on Chronic Pain Patients

Sascha Freigang; Christian Lehner; Shane M. Fresnoza; Kariem Mahdy Ali; Elisabeth Hlavka; Annika Eitler; Istvan Szilagyi; Helmar Bornemann-Cimenti; Hannes Deutschmann; Gernot Reishofer; Anže Berlec; Senta Kurschel-Lackner; Antonio Valentin; Bernhard Sutter; Karla Zaar; Michael Mokry

doi:10.3390/brainsci11080961

Comparing the impact of multi-session left dorsolateral prefrontal and primary motor cortex neuronavigated repetitive transcranial magnetic stimulation (nrTMS) on Chronic Pain Patients

Sascha Freigang^*, Christian Lehner, Shane M. Fresnoza, Kariem Mahdy Ali, Elisabeth Hlavka, Annika Eitler, Istvan Szilagyi, Helmar Bornemann-Cimenti, Hannes Deutschmann, Gernot Reishofer, Anže Berlec, Senta Kurschel-Lackner, Antonio Valentin, Bernhard Sutter, Karla Zaar, Michael Mokry

^*Corresponding author for this work

Basic and Clinical Neuroscience

Research output: Contribution to journal › Article › peer-review

12 Citations (Scopus)

Abstract

Repetitive transcranial stimulation (rTMS) has been shown to produce an analgesic effect and therefore has a potential for treating chronic refractory pain. However, previous studies used various stimulation parameters (including cortical targets), and the best stimulation protocol is not yet identified. The present study investigated the effects of multi-session 20 Hz (2000 pulses) and 5 Hz (1800 pulses) rTMS stimulation of left motor cortex (M1-group) and left dorsolateral prefrontal cortex (DLPFC-group), respectively. The M1-group (n = 9) and DLPFC-group (n = 7) completed 13 sessions of neuronavigated stimulation, while a Sham-group (n = 8) completed seven sessions of placebo stimulation. The outcome was measured using the German Pain Questionnaire (GPQ), Depression, Anxiety and Stress Scale (DASS), and SF-12 questionnaire. Pain perception significantly decreased in the DLPFC-group (38.17%) compared to the M1-group (56.11%) (p ≤ 0.001) on the later sessions. Health-related quality of life also improved in the DLPFC-group (40.47) compared to the Sham-group (35.06) (p = 0.016), and mental composite summary (p = 0.001) in the DLPFC-group (49.12) compared to M1-group (39.46). Stimulation of the left DLPFC resulted in pain relief, while M1 stimulation was not effective. Nonetheless, further studies are needed to identify optimal cortical target sites and stimulation parameters.

Original language	English
Article number	961
Journal	Brain Sciences
Volume	11
Issue number	8
DOIs	https://doi.org/10.3390/brainsci11080961
Publication status	Published - Aug 2021

Keywords

Chronic pain
Dorsolateral prefrontal cortex
Low back pain
Neuromodulation
Primary motor cortex
Repetitive transcranial magnetic stimulation

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Freigang, S., Lehner, C., Fresnoza, S. M., Ali, K. M., Hlavka, E., Eitler, A., Szilagyi, I., Bornemann-Cimenti, H., Deutschmann, H., Reishofer, G., Berlec, A., Kurschel-Lackner, S., Valentin, A., Sutter, B., Zaar, K., & Mokry, M. (2021). Comparing the impact of multi-session left dorsolateral prefrontal and primary motor cortex neuronavigated repetitive transcranial magnetic stimulation (nrTMS) on Chronic Pain Patients. Brain Sciences, 11(8), Article 961. https://doi.org/10.3390/brainsci11080961

@article{b4f5d077991d4da5aee8e45394064e75,

title = "Comparing the impact of multi-session left dorsolateral prefrontal and primary motor cortex neuronavigated repetitive transcranial magnetic stimulation (nrTMS) on Chronic Pain Patients",

abstract = "Repetitive transcranial stimulation (rTMS) has been shown to produce an analgesic effect and therefore has a potential for treating chronic refractory pain. However, previous studies used various stimulation parameters (including cortical targets), and the best stimulation protocol is not yet identified. The present study investigated the effects of multi-session 20 Hz (2000 pulses) and 5 Hz (1800 pulses) rTMS stimulation of left motor cortex (M1-group) and left dorsolateral prefrontal cortex (DLPFC-group), respectively. The M1-group (n = 9) and DLPFC-group (n = 7) completed 13 sessions of neuronavigated stimulation, while a Sham-group (n = 8) completed seven sessions of placebo stimulation. The outcome was measured using the German Pain Questionnaire (GPQ), Depression, Anxiety and Stress Scale (DASS), and SF-12 questionnaire. Pain perception significantly decreased in the DLPFC-group (38.17%) compared to the M1-group (56.11%) (p ≤ 0.001) on the later sessions. Health-related quality of life also improved in the DLPFC-group (40.47) compared to the Sham-group (35.06) (p = 0.016), and mental composite summary (p = 0.001) in the DLPFC-group (49.12) compared to M1-group (39.46). Stimulation of the left DLPFC resulted in pain relief, while M1 stimulation was not effective. Nonetheless, further studies are needed to identify optimal cortical target sites and stimulation parameters.",

keywords = "Chronic pain, Dorsolateral prefrontal cortex, Low back pain, Neuromodulation, Primary motor cortex, Repetitive transcranial magnetic stimulation",

author = "Sascha Freigang and Christian Lehner and Fresnoza, {Shane M.} and Ali, {Kariem Mahdy} and Elisabeth Hlavka and Annika Eitler and Istvan Szilagyi and Helmar Bornemann-Cimenti and Hannes Deutschmann and Gernot Reishofer and An{\v z}e Berlec and Senta Kurschel-Lackner and Antonio Valentin and Bernhard Sutter and Karla Zaar and Michael Mokry",

year = "2021",

month = aug,

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Freigang, S, Lehner, C, Fresnoza, SM, Ali, KM, Hlavka, E, Eitler, A, Szilagyi, I, Bornemann-Cimenti, H, Deutschmann, H, Reishofer, G, Berlec, A, Kurschel-Lackner, S, Valentin, A, Sutter, B, Zaar, K & Mokry, M 2021, 'Comparing the impact of multi-session left dorsolateral prefrontal and primary motor cortex neuronavigated repetitive transcranial magnetic stimulation (nrTMS) on Chronic Pain Patients', Brain Sciences, vol. 11, no. 8, 961. https://doi.org/10.3390/brainsci11080961

TY - JOUR

T1 - Comparing the impact of multi-session left dorsolateral prefrontal and primary motor cortex neuronavigated repetitive transcranial magnetic stimulation (nrTMS) on Chronic Pain Patients

AU - Freigang, Sascha

AU - Lehner, Christian

AU - Fresnoza, Shane M.

AU - Ali, Kariem Mahdy

AU - Hlavka, Elisabeth

AU - Eitler, Annika

AU - Szilagyi, Istvan

AU - Bornemann-Cimenti, Helmar

AU - Deutschmann, Hannes

AU - Reishofer, Gernot

AU - Berlec, Anže

AU - Kurschel-Lackner, Senta

AU - Valentin, Antonio

AU - Sutter, Bernhard

AU - Zaar, Karla

AU - Mokry, Michael

PY - 2021/8

Y1 - 2021/8

N2 - Repetitive transcranial stimulation (rTMS) has been shown to produce an analgesic effect and therefore has a potential for treating chronic refractory pain. However, previous studies used various stimulation parameters (including cortical targets), and the best stimulation protocol is not yet identified. The present study investigated the effects of multi-session 20 Hz (2000 pulses) and 5 Hz (1800 pulses) rTMS stimulation of left motor cortex (M1-group) and left dorsolateral prefrontal cortex (DLPFC-group), respectively. The M1-group (n = 9) and DLPFC-group (n = 7) completed 13 sessions of neuronavigated stimulation, while a Sham-group (n = 8) completed seven sessions of placebo stimulation. The outcome was measured using the German Pain Questionnaire (GPQ), Depression, Anxiety and Stress Scale (DASS), and SF-12 questionnaire. Pain perception significantly decreased in the DLPFC-group (38.17%) compared to the M1-group (56.11%) (p ≤ 0.001) on the later sessions. Health-related quality of life also improved in the DLPFC-group (40.47) compared to the Sham-group (35.06) (p = 0.016), and mental composite summary (p = 0.001) in the DLPFC-group (49.12) compared to M1-group (39.46). Stimulation of the left DLPFC resulted in pain relief, while M1 stimulation was not effective. Nonetheless, further studies are needed to identify optimal cortical target sites and stimulation parameters.

AB - Repetitive transcranial stimulation (rTMS) has been shown to produce an analgesic effect and therefore has a potential for treating chronic refractory pain. However, previous studies used various stimulation parameters (including cortical targets), and the best stimulation protocol is not yet identified. The present study investigated the effects of multi-session 20 Hz (2000 pulses) and 5 Hz (1800 pulses) rTMS stimulation of left motor cortex (M1-group) and left dorsolateral prefrontal cortex (DLPFC-group), respectively. The M1-group (n = 9) and DLPFC-group (n = 7) completed 13 sessions of neuronavigated stimulation, while a Sham-group (n = 8) completed seven sessions of placebo stimulation. The outcome was measured using the German Pain Questionnaire (GPQ), Depression, Anxiety and Stress Scale (DASS), and SF-12 questionnaire. Pain perception significantly decreased in the DLPFC-group (38.17%) compared to the M1-group (56.11%) (p ≤ 0.001) on the later sessions. Health-related quality of life also improved in the DLPFC-group (40.47) compared to the Sham-group (35.06) (p = 0.016), and mental composite summary (p = 0.001) in the DLPFC-group (49.12) compared to M1-group (39.46). Stimulation of the left DLPFC resulted in pain relief, while M1 stimulation was not effective. Nonetheless, further studies are needed to identify optimal cortical target sites and stimulation parameters.

KW - Chronic pain

KW - Dorsolateral prefrontal cortex

KW - Low back pain

KW - Neuromodulation

KW - Primary motor cortex

KW - Repetitive transcranial magnetic stimulation

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DO - 10.3390/brainsci11080961

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AN - SCOPUS:85112195415

SN - 2076-3425

VL - 11

JO - Brain Sciences

JF - Brain Sciences

IS - 8

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ER -

Comparing the impact of multi-session left dorsolateral prefrontal and primary motor cortex neuronavigated repetitive transcranial magnetic stimulation (nrTMS) on Chronic Pain Patients

Abstract

Keywords

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