Value of repetitive transcranial magnetic stimulation (rTMS) in upper extremity neuropathic pain rehabilitation

Abstract Background Pain that results from an injury or illness that affects the somatosensory system is known as neuropathic pain. Despite of presence of pharmacological and surgical treatments for that kind of pain, it has limited effectiveness because of side effects and surgical treatments invasiveness. Over the last several decades, chronic pain has been suggested to be treated with repetitive transcranial magnetic stimulation (rTMS) as non-invasive brain stimulation technique. Our aim in the current study is to evaluate rTMS efficacy in rehabilitation of neuropathic pain of the upper extremity. Methods Sixty patients with probable or definite upper extremity neuropathic pain based on the Neuropathic Pain Grading System took part in this randomized, double-blind, placebo-controlled study. Two equal groups were randomly selected among the patients receiving either active or sham rTMS for 12 weeks included one session every week. Both groups were asked to record mini-mental state examination (MMSE) Arabic version, Beck depression inventory, The European quality of life-5 dimension-5 level (EQ-5D-5L) questionnaire, numeric rating scale (NRS) for pain magnitude, Short-Form Mcmill Pain Questionnaire2 (SF-MPQ2 ), visual analog scale (VAS), and hand grip strength by hand dynamometer at baseline and after the last session. Results The two groups did not show statistically significant difference at baseline as regard age, sex, Pain intensity (NRS, VAS, and SF-MPQ2), hand grip strength, MMSE, Beck depression inventory and quality of life (EQ-5D-5L) ( p value > 0.05). After completing sessions, Active rTMS group showed significant decrease in pain intensity, significant improvement in Beck depression inventory scale, hand grip strength and quality-of-life (EQ-5D-5L) score ( p value ≤ 0.05). Placebo group did not show significant changes in pain intensity, Beck depression inventory scale, hand grip strength and EQ-5D-5L score ( p value > 0.05). Conclusions The rTMS was proven to be efficient in improvement of pain severity, depression, quality of life and hand grip strength among upper limb neuropathic pain patients. rTMS could be a promising treatment option in neuropathic pain patients.