TY - JOUR
T1 - Clinical effects and brain metabolic correlates in non-invasive cortical neuromodulation for visceral pain
AU - Fregni, Felipe
AU - Potvin, Kimberly
AU - Dasilva, Deborah
AU - Wang, Xiaoen
AU - Lenkinski, Robert E.
AU - Freedman, Steven D.
AU - Pascual-Leone, Alvaro
N1 - Funding Information:
Grant support : This work was supported by a grant from NIH (DK071851-01 SDF) and the Harvard-Thorndike Clinical Research Center at Beth Israel Deaconess Medical Center integrated in the Harvard Clinical and Translational Science Center, supported by grants M01-RR-01066 and UL1 RR025758 from the National Center for Research Resources, National Institutes of Health. A.P.L. is supported by a grant from the National Institutes of Health (K24 RR018875). F.F. is supported by grant from NIH R21DK081773. Appendix A
PY - 2011/1
Y1 - 2011/1
N2 - Background and aims: Chronic visceral pain is frequent, extremely debilitating, and generally resistant to pharmacological treatment. It has been shown that chronic visceral inflammation, through altered afferent visceral sensory input, leads to plastic changes in the central nervous system that ultimately sustain pain. Therefore approaches aiming at modulation of brain activity are attractive candidates to control visceral pain. Methods: Here we report findings of a phase II, sham-controlled clinical trial assessing the clinical effects and brain metabolic correlates of a 10-day course of daily sessions of slow-frequency, repetitive transcranial magnetic stimulation (rTMS) targeting the right secondary somatosensory cortex (SII) in patients with chronic pancreatitis and severe visceral pain. Results: Our results show a significant reduction in pain after real rTMS that lasted for at least 3 weeks following treatment. These clinical changes were correlated with increases in glutamate and N-acetyl aspartate (NAA) levels - neurometabolites associated with cortical activity and brain damage - as measured by in vivo single-voxel proton magnetic resonance spectroscopy (1H-MRS). Adverse effects in the real rTMS group were mild and short-lasting. Conclusions: Our results support preliminary findings showing that modulation of right SII with rTMS is associated with a significant analgesic effect and that this effect is correlated with an increase in excitatory neurotransmitter levels such as glutamate and NAA.
AB - Background and aims: Chronic visceral pain is frequent, extremely debilitating, and generally resistant to pharmacological treatment. It has been shown that chronic visceral inflammation, through altered afferent visceral sensory input, leads to plastic changes in the central nervous system that ultimately sustain pain. Therefore approaches aiming at modulation of brain activity are attractive candidates to control visceral pain. Methods: Here we report findings of a phase II, sham-controlled clinical trial assessing the clinical effects and brain metabolic correlates of a 10-day course of daily sessions of slow-frequency, repetitive transcranial magnetic stimulation (rTMS) targeting the right secondary somatosensory cortex (SII) in patients with chronic pancreatitis and severe visceral pain. Results: Our results show a significant reduction in pain after real rTMS that lasted for at least 3 weeks following treatment. These clinical changes were correlated with increases in glutamate and N-acetyl aspartate (NAA) levels - neurometabolites associated with cortical activity and brain damage - as measured by in vivo single-voxel proton magnetic resonance spectroscopy (1H-MRS). Adverse effects in the real rTMS group were mild and short-lasting. Conclusions: Our results support preliminary findings showing that modulation of right SII with rTMS is associated with a significant analgesic effect and that this effect is correlated with an increase in excitatory neurotransmitter levels such as glutamate and NAA.
KW - Brain metabolites
KW - Brain stimulation
KW - Chronic pain
KW - Magnetic resonance spectroscopy
KW - Neuromodulation
KW - Transcranial magnetic stimulation
KW - Visceral pain
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U2 - 10.1016/j.ejpain.2010.08.002
DO - 10.1016/j.ejpain.2010.08.002
M3 - Article
C2 - 20822942
AN - SCOPUS:78650739691
SN - 1090-3801
VL - 15
SP - 53
EP - 60
JO - European Journal of Pain
JF - European Journal of Pain
IS - 1
ER -