Gyu-sik Choi, Sang Gyu Kwak, Han Do Lee , Min Cheol Chang
Cheokbareun Rehabilitation Clinic, Pohang-si, Gyeongsangbuk-do, South Korea
DOI: 10.2340/16501977-2321

Objective: Central pain can occur following traumatic brain injury, leading to poor functional recovery, limitation of activities of daily living, and decreased quality of life. The aim of this study was to determine whether high-frequency (10 Hz) repetitive transcranial magnetic stimulation, applied over the primary motor cortex of the affected hemisphere, can be used to manage chronic central pain after mild traumatic brain injury.
Design: Prospective randomized feasibility study.
Methods: Twelve patients with mild traumatic brain injury and chronic central pain were randomly assigned to transcranial magnetic stimulation (high-frequency stimulation, 10 sessions) or sham groups. Diffuse tensor tractography revealed partially injured spinothalamocortical tracts in all recruited patients. A numerical rating scale (NRS) was used to evaluate pain intensity during pre-treatment and immediately after the 5th transcranial magnetic stimulation session (post1), 10th transcranial magnetic stimulation session (post2), and 1 (post3), 2 (post4), and 4 weeks (post 5) after finishing treatment. Physical and mental health status were evaluated using the Short Form 36 Health Survey (SF-36), including physical and mental component scores (PCS, MCS).
Results: The NRS score of the repetitive transcranial magnetic stimulation group was significantly lower than the sham group score at all clinical evaluation time-points during and after transcranial magnetic stimulation sessions. The transcranial magnetic stimulation group’s SF-36 PCS score was significantly higher at post2, post3, post4, and post5 compared with the sham group.
Conclusion: High-frequency transcranial magnetic stimulation may be used to manage chronic central pain and improve quality of life in patients with mild traumatic brain injury. However, this is a pilot study and further research is needed.

Repetitive transcranial magnetic stimulation (rTMS) is known to be effective for managing various chronic pain conditions. In this study, we evaluated the effects of high-frequency (10 Hz) rTMS applied over the primary motor cortex (M1) for the management of medically intractable chronic central pain after mild traumatic brain injury (TBI). Twelve patients with intractable chronic central pain after mild TBI were randomly assigned to 2 groups: the rTMS or sham groups (n = 6 patients per group). Each patient underwent 10 consecutive sessions for 2 weeks. After high-frequency rTMS on the M1, the severity of pain significantly decreased than the sham group, and the decrease in pain persisted for at least 4 weeks after completion of rTMS treatment. Also, physical quality of life was improved during and after rTMS sessions in the rTMS group. Therefore, rTMS would be a useful therapeutic option for patients suffering from chronic central pain after mild TBI.