• Liciane F Medeiros, Wolnei Caumo, Jairo Dussán-Sarria, Alicia Deitos, Aline Brietzke, Gabriela Laste, Cristina Campos-Carraro, Andressa de Souza, Vanessa L Scarabelot, Stefania G Cioato, Rafael Vercelino, ... more Alexandre L de Castro, Alex Sander Araújo, Adriane Belló-Klein, Felipe Fregni, and Iraci L S Torres. less
• Pain Med. 2016 Jan 1; 17 (1): 122-35.

ObjectiveThe aim was to assess the neuromodulation techniques effects (repetitive transcranial magnetic stimulation [rTMS] and deep intramuscular stimulation therapy [DIMST]) on pain intensity, peripheral, and neurophysiological biomarkers chronic myofascial pain syndrome (MPS) patients.DesignRandomized, double blind, factorial design, and controlled placebo-sham clinical trial.SettingClinical trial in the Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (NCT02381171).SubjectsWe recruited women aged between 19- and 75-year old, with MPS diagnosis.MethodsPatients were randomized into four groups: rTMS + DIMST, rTMS + sham-DIMST, sham-rTMS + DIMST, sham-rTMS + sham-DIMST; and received 10 sessions for 20 minutes each one (rTMS and DIMST). Pain was assessed by visual analogue scale (VAS); neurophysiological parameters were assessed by transcranial magnetic stimulation; biochemical parameters were: BDNF, S100β, lactate dehydrogenase, inflammatory (TNF-α, IL6, and IL10), and oxidative stress parameters.ResultsWe observed the pain relief assessed by VAS immediately assessed before and after the intervention (P < 0.05, F(1,3)= 3.494 and F(1,3)= 4.656, respectively); in the sham-rTMS + DIMST group and both three active groups in relation to sham-rTMS + sham-DIMST group, respectively. There was an increase in the MEP after rTMS + sham-DIMST (P < 0.05). However, there was no change in all-peripheral parameters analyzed across the treatment (P > 0.05).ConclusionOur findings add additional evidence about rTMS and DIMST in relieving pain in MPS patients without synergistic effect. No peripheral biomarkers reflected the analgesic effect of both techniques; including those related to cellular damage. Additionally, one neurophysiological parameter (increased MEP amplitude) needs to be investigated.Published by Oxford University Press on behalf of the American Academy of Pain Medicine. 2016. This work is written by US Government employees and is in the public domain in the US.

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