Repetitive Transcranial Magnetic Stimulation is Efficacious as an Add-On to Pharmacological Therapy in Complex Regional Pain Syndrome (CRPS) Type I

Helder Picarelli,* Manoel Jacobsen Teixeira,* Daniel Ciampi de Andrade, MD,*,y,z Martin Luiz Myczkowski,z Tatiana Barreira Luvisotto,z Lin Tchia Yeng,* Erich Talamoni Fonoff,* Saxby Pridmore,x and Marco Antonio Marcolinz *Clinic of Pain, Department of Neurology, University of Sa˜o Paulo, Brazil. y 

Pain Clinic from the Institute of Cancer of The State of São Paulo, University of São Paulo, Brazil.
Laboratory of Transcranial Magnetic Stimulation, Department of Psychiatry, University of São Paulo, Brazil.
Clinical Professor, Division of Psychiatry, University of Tasmania, Hobart, Tasmania, Australia.


Single-session repetitive transcranial magnetic stimulation (rTMS) of the motor cortex (M1) is effective in the treatment of chronic pain patients, but the analgesic effect of repeated sessions is still unknown. We evaluated the effects of rTMS in patients with refractory pain due to complex regional pain syndrome (CRPS) type I. Twenty-three patients presenting CRPS type I of 1 upper limb were treated with the best medical treatment (analgesics and adjuvant medications, physical therapy) plus 10 daily sessions of either real (r-) or sham (s-) 10 Hz rTMS to the motor cortex (M1). Patients were assessed daily and after 1 week and 3 months after the last session using the Visual Analogical Scale (VAS), the McGill Pain Questionnaire (MPQ), the Health Survey-36 (SF-36), and the Hamilton Depression (HDRS). During treatment there was a significant reduction in the VAS scores favoring the r-rTMS group, mean reduction of 4.65 cm (50.9%) against 2.18 cm (24.7%) in the s-rTMS group. The highest reduction occurred at the tenth session and correlated to improvement in the affective and emotional subscores of the MPQ and SF-36. Real rTMS to the M1 produced analgesic effects and positive changes in affective aspects of pain in CRPS patients during the period of stimulation.


This study shows an efficacy of repetitive sessions of high-frequency rTMS as an add-on therapy to refractory CRPS type I patients. It had a positive effect in different aspects of pain (sensory-discriminative and emotional-affective). It opens the perspective for the clinical use of this technique.

Copyright © 2010 American Pain Society. Published by Elsevier Inc. All rights reserved.

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