Authors:

Moisset X; de Andrade DC; Bouhassira D. Institution

Moisset, X. Inserm U-987, Centre d’Evaluation et de Traitement de la Douleur, CHU Ambroise Pare, Assistance Publique Hopitaux de Paris, Boulogne Billancourt, France. Moisset, X. Clermont Universite, Universite d’Auvergne, Neuro-Dol, Inserm U-1107, Clermont-Ferrand, France. Moisset, X. Service de Neurologie, CHU Gabriel Montpied, Clermont Universite, Universite d’Auvergne, Clermont-Ferrand, France. de Andrade, D C. Department of Neurology, Pain Center, University of Sao Paulo, Brazil. de Andrade, D C. Transcranial Magnetic Stimulation Laboratory, Institutode Psiquiatria, University of Sao Paulo, Brazil.de Andrade, D C. Instituto do Cancer Octavio Frias de Oliveira, University of Sao Paulo, Brazil. Bouhassira, D. Inserm U-987, Centre d’Evaluation et de Traitement de la Douleur, CHU Ambroise Pare, Assistance Publique Hopitaux de Paris, Boulogne Billancourt, France. Bouhassira, D. Universite Versailles-Saint-Quentin, Versailles, France.

Title:

From pulses to pain relief: an update on the mechanisms of rTMS-induced analgesic effects.

Source:

European Journal of Pain. 20(5):689-700, 2016 May

Abstract:

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive technique that allows cortical stimulation. Recent studies have shown that rTMS of the primary motor cortex or dorsolateral prefrontal cortex decreases pain in various pain conditions. The aim of this review was to summarize the main characteristics of rTMS-induced analgesic effects and to analyse the current data on its mechanisms of action.

DATABASES: Medline, PubMed and Web of Science were searched for studies on the analgesic effects and mechanisms of rTMS-induced analgesic effects. Studies on epidural motor cortex stimulation (EMCS) were also included when required, as several mechanisms of action are probably shared between both techniques.

RESULTS: Stimulation site and stimulation parameters have a major impact on rTMS-related analgesic effects. Local cortical stimulation is able to elicit changes in the functioning of distant brain areas. These modifications outlast the duration of the rTMS session and probably involve LTP-like mechanisms via its influence on glutamatergic networks. Analgesic effects seem to be correlated to restoration of normal cortical excitability in chronic pain patients and depend on pain modulatory systems, in particular endogenous opioids. Dopamine, serotonin,

norepinephrine and GABAergic circuitry may also be involved in its