• Ruth Defrin, Leon Grunhaus, Doron Zamir, and Gabi Zeilig.
• Department of Physical Therapy, Sackler Medical School, Tel-Aviv University, Ramat Aviv, Israel. rutidef@post.tau.ac.il
• Arch Phys Med Rehabil. 2007 Dec 1;88(12):1574-80.

ObjectiveTo study the analgesic effect of repetitive transcranial magnetic stimulation (rTMS) of the motor cortex on central pain in patients with chronic spinal cord injury (SCI).DesignDouble-blind randomized controlled trial. Mean follow-up period was 4.5 weeks.SettingGeneral hospital.ParticipantsTwelve paraplegic patients due to thoracic SCI suffering chronic central pain (11 completed the study) who were randomly selected from a list of eligible patients.InterventionReal or sham 10 daily motor rTMS treatments (500 trains at 5 Hz for 10 s; total of 500 pulses at intensity of 115% of motor threshold) using figure-of-8 coil over the vertex.Main Outcome MeasuresChronic pain intensity (visual analog scale [VAS], McGill Pain Questionnaire [MPQ]), pain threshold, and level of depression (Beck Depression Inventory).ResultsBoth real and sham TMS induced a similar, significant reduction in VAS scores (P<.001) immediately after each of the 10 treatment sessions and in VAS and MPQ scores after the end of the treatment series. However, only real rTMS conferred a significant increase in heat-pain threshold (4 degrees C, P<.05) by the end of the series. Most important, the reduction in MPQ scores in the real rTMS group continued during the follow-up period. Depression scores were equally reduced in both groups but similar to pain relief, depression continued to improve at follow-up in the real rTMS group.ConclusionsWhereas the pain alleviation induced by a single rTMS treatment is probably due to placebo, patients with SCI may benefit from a series of rTMS treatments.

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