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

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dc.contributor Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP MOISSET, X.
dc.identifier.citation EUROPEAN JOURNAL OF PAIN, v.20, n.5, p.689-700, 2016
dc.identifier.issn 1090-3801
dc.description.abstract BackgroundRepetitive 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. DatabasesMedline, 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. ResultsStimulation 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 effects, as well as rostrocaudal projections. ConclusionsrTMS activates brain areas distant from the stimulation site. LTP-like mechanisms, dependence on endogenous opioids and increase in concentration of neurotransmitters (monoamines, GABA) have all been implicated in its analgesic effects, although more studies are needed to fill in the still existing gaps in the understanding of its mechanisms of action.
dc.language.iso eng
dc.publisher WILEY-BLACKWELL
dc.relation.ispartof European Journal of Pain
dc.rights restrictedAccess
dc.subject.other transcranial magnetic stimulation; motor cortex stimulation; chronic neuropathic pain; theta-burst stimulation; left prefrontal rtms; central poststroke pain; spinal-cord-injury; intractable deafferentation pain; sham-controlled trial; dopamine d2 receptor
dc.title From pulses to pain relief: an update on the mechanisms of rTMS-induced analgesic effects
dc.type article
dc.rights.holder Copyright WILEY-BLACKWELL
dc.identifier.doi 10.1002/ejp.811
dc.identifier.pmid 26471248
dc.type.category review
dc.type.version publishedVersion ANDRADE, D. C. de:HC:ICESP · MOISSET, X.:CHU Ambroise Pare, AP HP, Ctr Evaluat & Traitement Douleur, INSERM,U987, Boulogne Billancourt, France; Univ Auvergne, Univ Clermont Ferrand 2, Neurodol, INSERM,U1107, Clermont Ferrand, France; Univ Auvergne, Univ Clermont Ferrand 2, CHU Gabriel Montpied, Serv Neurol, Clermont Ferrand, France
· BOUHASSIRA, D.:CHU Ambroise Pare, AP HP, Ctr Evaluat & Traitement Douleur, INSERM,U987, Boulogne Billancourt, France; Univ Versailles St Quentin, Versailles, France WOS:000373997600003 2-s2.0-84951867080 HOBOKEN USA
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dc.description.index MEDLINE
dc.identifier.eissn 1532-2149
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