Shaped magnetic field pulses by multi-coil repetitive transcranial magnetic stimulation (rTMS) differentially modulate anterior cingulate cortex responses and pain in volunteers and fibromyalgia patients

Molecular Pain

David C Yeomans³  Amit Etkin¹  M Bret Schneider²  Michael C Rowbotham⁴  Carina Mari Aparici⁵  Alexander Tzabazis³ 

[1] Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA;Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA;Department of Anesthesiology, Pain, and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA, USA;California Pacific Medical Center Research Institute, San Francisco, CA, USA;Department of Radiology, University of California San Francisco, San Francisco, CA, USA

关键词: Psychophysics;    Functional imaging;    Multi coil;    Fibromyalgia;    Chronic pain;    Acute pain;    Transcranial magnetic simulation;    Pain;   

Others  :  862419
DOI  :  10.1186/1744-8069-9-33

 received in 2013-04-08, accepted in 2013-06-29,  发布年份 2013

【 摘 要 】

Background

Repetitive transcranial magnetic stimulation (rTMS) has shown promise in the alleviation of acute and chronic pain by altering the activity of cortical areas involved in pain sensation. However, current single-coil rTMS technology only allows for effects in surface cortical structures. The ability to affect activity in certain deep brain structures may however, allow for a better efficacy, safety, and tolerability. This study used PET imaging to determine whether a novel multi-coil rTMS would allow for preferential targeting of the dorsal anterior cingulate cortex (dACC), an area always activated with pain, and to provide preliminary evidence as to whether this targeted approach would allow for efficacious, safe, and tolerable analgesia both in a volunteer/acute pain model as well as in fibromyalgia chronic pain patients.

Methods

Part 1: Different coil configurations were tested in a placebo-controlled crossover design in volunteers (N = 16). Tonic pain was induced using a capsaicin/thermal pain model and functional brain imaging was performed by means of H₂¹⁵O positron emission tomography – computed tomography (PET/CT) scans. Differences in NRS pain ratings between TMS and sham treatment (NRS_TMS-NRS_placebo) which were recorded each minute during the 10 minute PET scans. Part 2: 16 fibromyalgia patients were subjected to 20 multi-coil rTMS treatments over 4 weeks and effects on standard pain scales (Brief Pain Inventory, item 5, i.e. average pain NRS over the last 24 hours) were recorded.

Results

A single 30 minute session using one of 3 tested rTMS coil configurations operated at 1 Hz consistently produced robust reduction (mean 70% on NRS scale) in evoked pain in volunteers. In fibromyalgia patients, the 20 rTMS sessions also produced a significant pain inhibition (43% reduction in NRS pain over last 24 hours), but only when operated at 10 Hz. This degree of pain control was maintained for at least 4 weeks after the final session.

Conclusion

Multi-coil rTMS may be a safe and effective treatment option for acute as well as for chronic pain, such as that accompanying fibromyalgia. Further studies are necessary to optimize configurations and settings as well as to elucidate the mechanisms that lead to the long-lasting pain control produced by these treatments.

【 授权许可】

   
2013 Tzabazis et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Epstein CM, Zangaladze A: Magnetic coil suppression of extrafoveal visual perception using disappearance targets. J Clin Neurophysiol : official publication of the American Electroencephalographic Society 1996, 13:242-246.
• [2]André-Obadia N, Peyron R, Mertens P, Mauguière F, Laurent B, Garcia-Larrea L: Transcranial magnetic stimulation for pain control. Double-blind study of different frequencies against placebo, and correlation with motor cortex stimulation efficacy. Clin Neurophysiol 2006, 117:1536-1544.
• [3]Hirayama A, Saitoh Y, Kishima H, Shimokawa T, Oshino S, Hirata M, Kato A, Yoshimine T: Reduction of intractable deafferentation pain by navigation-guided repetitive transcranial magnetic stimulation of the primary motor cortex. Pain 2006, 122:22-27.
• [4]Borckardt JJ, Smith AR, Reeves ST, Madan A, Shelley N, Branham R, Nahas Z, George MS: A pilot study investigating the effects of fast left prefrontal rTMS on chronic neuropathic pain. Pain medicine (Malden, Mass) 2009, 10:840-849.
• [5]Zangen A, Hyodo K: Transcranial magnetic stimulation induces increases in extracellular levels of dopamine and glutamate in the nucleus accumbens. Neuroreport 2002, 13:2401-2405.
• [6]Epstein CM, Davey KR: Iron-core coils for transcranial magnetic stimulation. J Clin Neurophysiol : official publication of the American Electroencephalographic Society 2002, 19:376-381.
• [7]Roth Y, Amir A, Levkovitz Y, Zangen A: Three-dimensional distribution of the electric field induced in the brain by transcranial magnetic stimulation using figure-8 and deep H-coils. J Clin Neurophysiol : official publication of the American Electroencephalographic Society 2007, 24:31-38.
• [8]Deng Z-D, Lisanby SH, Peterchev AV: Electric field depth-focality tradeoff in transcranial magnetic stimulation: Simulation comparison of 50 coil designs. Brain Stimul 2013, 6:1-13.
• [9]Eisenberger NI: The pain of social disconnection: examining the shared neural underpinnings of physical and social pain. Nat Rev Neurosci 2012, 13:421-34.
• [10]Freund W, Klug R, Weber F, Stuber G, Schmitz B, Wunderlich AP: Perception and suppression of thermally induced pain: a fMRI study. Somatosens Mot Res 2009, 26:1-10.
• [11]Lieberman MD, Jarcho JM, Berman S, Naliboff BD, Suyenobu BY, Mandelkern M, Mayer EA: The neural correlates of placebo effects: a disruption account. Neuroimage 2004, 22:447-55.
• [12]Burgmer M, Gaubitz M, Konrad C, Wrenger M, Hilgart S, Heuft G, Pfleiderer B: Decreased gray matter volumes in the cingulo-frontal cortex and the amygdala in patients with fibromyalgia. Psychosom Med 2009, 71:566-73.
• [13]Lutz J, Jäger L, De Quervain D, Krauseneck T, Padberg F, Wichnalek M, Beyer A, Stahl R, Zirngibl B, Morhard D, Reiser M, Schelling G: White and gray matter abnormalities in the brain of patients with fibromyalgia: a diffusion-tensor and volumetric imaging study. Arthritis Rheum 2008, 58:3960-9.
• [14]Chapin H, Bagarinao E, Mackey S: Real-time fMRI applied to pain management. Neurosci Lett 2012, 520:174-81.
• [15]Guangchen J, Neugebauer V: Pain-related deactivation of medial prefrontal cortical neurons involves mGluR1 and GABA(A) receptors. J Neurophysiol 2011, 106:2642-52.
• [16]Short EB, Borckardt JJ, Anderson BS, Frohman H, Beam W, Reeves ST, George MS: Ten sessions of adjunctive left prefrontal rTMS significantly reduces fibromyalgia pain: a randomized, controlled pilot study. Pain 2011, 152:2477-84.
• [17]Loo CK, Taylor JL, Gandevia SC, McDarmont BN, Mitchell PB, Sachdev PS: Transcranial magnetic stimulation (TMS) in controlled treatment studies: are some “sham” forms active? Biol Psychiatry 2000, 47:325-31.
• [18]Price DD, Long S, Wilsey B, Rafii A: Analysis of peak magnitude and duration of analgesia produced by local anesthetics injected into sympathetic ganglia of complex regional pain syndrome patients. Clin J Pain 1998, 14:216-26.
• [19]Burckhardt CS, Clark SR, Bennett RM: The fibromyalgia impact questionnaire: development and validation. J Rheumatol 1991, 18:728-33.
• [20]Beck AT, Steer RA, Ball R, Ranieri W: Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. J Pers Assess 1996, 67:588-97.
• [21]Matthews JN, Altman DG, Campbell MJ, Royston P: Analysis of serial measurements in medical research. BMJ (Clinical research ed) 1990, 300:230-5.
• [22]Etkin A, Egner T, Kalisch R: Emotional processing in anterior cingulate and medial prefrontal cortex. Trends Cogn Sci 2011, 15:85-93.