Effects of high-frequency repetitive transcranial magnetic stimulation combined with acupuncture on central pain and mood

Objective This study aimed to observe the clinical efficacy of multi-target high-frequency repetitive transcranial magnetic stimulation (rTMS) combined with acupuncture for chronic central post-stroke pain (CPSP) and emotional comorbidities during the recovery phase. Methods Thirty patients with CPSP admitted to the Rehabilitation Department of Hubei Third People’s Hospital from June 2024 to June 2025 were randomly assigned to an acupuncture group (n=15) and a combined treatment group (n=15). The acupuncture group received routine rehabilitation plus acupuncture; the combined group received, in addition, multi-target rTMS targeting the contralateral primary motor cortex (M1) and the left dorsolateral prefrontal cortex (DLPFC), both at 10 Hz, for 4 weeks. Outcomes were assessed at baseline and after 4 weeks using the Visual Analogue Scale (VAS) for pain, Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) for mood, Pittsburgh Sleep Quality Index (PSQI) for sleep, and Activities of Daily Living (ADL) for functional status. Results After 4 weeks, a linear mixed model (LMM) analysis revealed a significant main effect of Time for all outcomes (VAS, HAMA, HAMD, PSQI, ADL; all P < 0.001), indicating overall improvement across both groups. A significant Group × Time interaction was found for VAS (P = 0.018) and HAMD (P = 0.037), demonstrating that the combined treatment group experienced significantly greater improvements in pain and depression compared to the acupuncture-only group. No significant interactions were observed for HAMA (P = 0.226), PSQI (P = 0.343), or ADL (P = 0.210). Conclusion Acupuncture confers clinical benefit in CPSP, whereas the addition of multi-target high-frequency rTMS yields superior analgesic and psychotropic effects. This combined approach has considerable clinical value for patients in the post-stroke recovery phase.