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Objectives: Central neuropathic pain (CNP) often appears following spinal cord injury (SCI), but current treatments are not always successful. In this study, we evaluated the analgesic effects of repetitive transcranial magnetic stimulation (rTMS) applied over the hand area of the motor cortex in patients with acute CNP after SCI., Methods: A total of 48 patients with complete or incomplete SCI and acute CNP participated in this study and were randomized to receive either rTMS (10 Hz, 1,500 stimuli; N = 24) or a sham intervention (N = 24) for three weeks. The numeric rating scale (NRS) and Short-Form McGill Pain Questionnaire-2 (Chinese Edition; SF-MPQ-2-CN) were analyzed to assess the degree of pain. Brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) were collected to explore expression influenced by rTMS. Motor-evoked potential (MEP) latency and maximal amplitude were measured to determine neurophysiological changes. The assessments were carried out at baseline (T0), three days (T1), one week (T2), two weeks (T3), and three weeks (T4) after onset of treatment., Results: The analysis showed significant treatment-time interactions for the quality and intensity of pain, as measured by NRS (P < 0.001, η2 = 0.441) and SF-MPQ-2 (P < 0.001, η2 = 0.590). Compared with the sham group, the NRS and SF-MPQ2-CN scores were significantly lower on the third day (P < 0.001, Cohen's d = 1.135; P = 0.006, Cohen's d = 0.616) and after one week (P < 0.001, Cohen's d = 0.846; P = 0.012, Cohen's d = 0.557) of treatment. In addition, the serum levels of BDNF and NGF were significantly higher in the treated group after three weeks (P = 0.015, Cohen's d = 0.539; P = 0.009, Cohen's d = 0.580), and the MEP amplitude increased by 109.59% (P = 0.033, Cohen's d = 0.464)., Conclusions: These findings indicate that 10 Hz rTMS over the hand area of the motor cortex could alleviate acute CNP in the early phase of SCI and could enhance MEP parameters and modulate BDNF and NGF secretion., (© 2019 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective To investigate the effect of high⁃frequency repetitive transcranial magnetic stimulation (rTMS) on pain and emotion in patients with neuropathic pain (NP) combined with anxiety and/or depression. Methods A total of 39 patients with NP combined with anxiety and/or depression from June 2019 to October 2021 were included and randomly divided into conventional treatment combined with sham stimulation group (control group, n=19) and conventional treatment⁃assisted high⁃frequency rTMS (rTMS group, n=20). The Numerical Rating Scale (NRS) was used to evaluate the pain state, Hamilton Anxiety Scale⁃14 (HAMA⁃14) was used to evaluate the anxiety state, and Hamilton Depression Scale⁃17 (HAMD⁃17) was used to evaluate depression state before treatment and at 3 days, 1 week, 2 weeks, 3 weeks and 4 weeks of treatment. Results The NRS score (F=23.573, P=0.000) and HAMD score (F=15.426, P=0.000) before and after treatment were significantly different between the 2 groups. The NRS score and HAMD score in rTMS group were lower than those in control group at 1, 2, 3 and 4 weeks of treatment (P≤0.01, for all). The differences in NRS score (F=317.751, P=0.000), HAMA score (F=81.510, P=0.000) and HAMD score (F=32.773, P=0.000) at different observation times were also statistically significant in the same treatment group. In rTMS group, NRS score and HAMD score at 1, 2, 3 and 4 weeks of treatment were lower than those before treatment and 3 days of treatment (P＜0.01, for all), and HAMA score at 1, 2 and 3 weeks of treatment were lower than those before treatment and 3 days of treatment (P=0.000, for all). HAMA score at 4 weeks of treatment was lower than that before treatment (P=0.007), at 1 week (P=0.014) and 2 weeks (P=0.001) of treatment. In control group, NRS score only at 4 weeks of treatment was lower than that before treatment (P=0.000), HAMA score at 1, 2 and 3 weeks of treatment was lower than those before treatment (P＜0.05, for all), and HAMA score at 1 week of treatment was lower than that at 3 days of treatment (P=0.002). Spearman correlation analysis showed that the degree of pain relief before and after treatment was positively correlated with the ease of anxiety (rs=0.442, P=0.048) and depression (rs=0.705, P=0.001). Conclusions High⁃frequency rTMS is a safe and effective treatment for NP with anxiety and/or depression. It can significantly ease anxiety and depression in patients while relieving pain.

Background: Neuropathic pain (NP) is a common and severe problem following spinal cord injury (SCI). However, its relationship with functional outcome remains unclear.Methods: A retrospective explorative analysis was performed on SCI patients admitted to a tertiary academic medical center between January 2018 and June 2022. The candidate predictor variables, including demographics, clinical characteristics and complications, were analyzed with logistic and linear regression. Spinal Cord Independence Measure (SCIM) scores at discharge and mean relative functional gain (mRFG) of SCIM were as outcome parameters.Results: A total of 140 SCI patients included for the final analysis. Among them, 44 (31.43%) patients were tetraplegics, and 96 (68.57%) patients were paraplegics; 68 (48.57%) patients developed NP, and 72 (51.43%) patients did not. Logistic and linear regression analyses of SCIM at discharge both showed that NP [OR=3.10, 95% CI (1.29,7.45), P=0.01; unstandardized β=11.47, 95% CI (4.95,17.99), P< 0.01; respectively] was significantly independent predictors for a favorable outcome (SCIM at discharge ≥ 50, logistic regression results) and higher SCIM total score at discharge (linear regression results). Besides, NP [unstandardized β=15.67, 95% CI (8.94,22.41), P< 0.01] was also independently associated with higher mRFG of SCIM scores. Furthermore, the NP group had significantly higher mRFG, SCIM total scores and subscales (self-care, respiration and sphincter management, and mobility) at discharge compared to the non-NP group. However, there were no significant differences in mRFG, SCIM total score or subscales at discharge among the NP subgroups in terms of locations (at level pain, below level pain, and both) or timing of occurrence (within and after one month after SCI). This study also showed that incomplete injury, lumbar-sacral injury level and non-anemia were significantly independent predictors for a favorable outcome, and higher mRFG of SCIM scores (except for non-anemia).Conclusion: NP appears independently associated with better functional recovery in SCI patients, suggesting the bright side of this undesirable complication. These findings may help to alleviate the psychological burden of NP patients and ultimately restore their confidence in rehabilitation. [ABSTRACT FROM AUTHOR]

Introduction: Central poststroke pain (CPSP) develops commonly after stroke, which impairs the quality of life, mood, and social functioning. Current pharmacological approaches for the treatment of CPSP are not satisfactory. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive technique which has been recommended for the treatment of chronic CPSP. However, few studies have evaluated the analgesic effects of rTMS in patients with acute neuropathic pain after stroke. Methods: We evaluated the analgesic effects of rTMS applied over the upper extremity area of the motor cortex (M1) in patients with acute CPSP. Forty patients were randomized to receive either rTMS (10 Hz, 2000 stimuli) (n = 20) or a sham intervention (n = 20) for 3 weeks. The Numeric Rating Scale (NRS), Short-form McGill Pain Questionnaire-2 (SF-MPQ-2, Chinese version), Hamilton Anxiety Scale (HAM-A), Hamilton Depression Scale (HAM-D), brain-derived neurotrophic factor (BDNF) levels, and motor-evoked potentials (MEP) were analyzed at baseline, 3 days, 1 week, 2 weeks, and 3 weeks. Results: Significant treatment–time interactions were found for pain intensity. Compared with the sham group, the NRS and SF-MPQ-2 scores were significantly lower on the seventh day of treatment in the rTMS group (P < 0.001, Cohen's d = 1.302) (P = 0.003, Cohen's d = 0.771), and this effect lasted until the third week (P = 0.001, Cohen's d = 0.860) (P = 0.027, Cohen's d = 0.550). The HAM-A and HAM-D scores did not change in the rTMS group when compared with the sham group (P = 0.341, Cohen's d = 0.224) (P = 0.356, Cohen's d = 0.217). The serum BDNF levels were significantly higher in the treated group (P = 0.048, Cohen's d = −0.487), and the resting motor threshold (RMT) decreased by 163.65%. Conclusion: Our findings indicate that rTMS applied over the upper extremity area of the motor cortex can effectively alleviate acute CPSP, possibly by influencing cortical excitability and serum BDNF secretion. Trial Registration: This trial is registered with Clinical Trial Registry of China: Reg. No. ChiCTR-INR-17012880. [ABSTRACT FROM AUTHOR]