Presentation of relative effects regarding pain will facilitate interpretation of treatment effects
OBJECTIVE Pain is a patient-important outcome , but current reporting in r and omized controlled trials and systematic review s is often suboptimal , impeding clinical interpretation and decision making .
Motor cortex rTMS restores defective intracortical inhibition in chronic neuropathic pain
Objective : To assess cortical excitability changes in patients with chronic neuropathic pain at baseline and after repetitive transcranial magnetic stimulation ( rTMS ) of the motor cortex . Methods : In 22 patients with unilateral h and pain of various neurologic origins and 22 age-matched healthy controls , we studied the following parameters of cortical excitability : motor threshold at rest , motor evoked potential amplitude ratio at two intensities , cortical silent period ( CSP ) , and intracortical inhibition ( ICI ) and intracortical facilitation . We compared these parameters between healthy subjects and patients at baseline . We also studied excitability changes in the motor cortex corresponding to the painful h and of patients after active or sham rTMS of this cortical region at 1 or 10 Hz . Results : At baseline , CSP was shortened for the both hemispheres of patients vs healthy subjects , in correlation with pain score , while ICI was reduced only for the motor cortex corresponding to the painful h and . Regarding rTMS effects , the single significant change was ICI increase in the motor cortex corresponding to the painful h and , after active 10-Hz rTMS , in correlation with pain relief . Conclusion : Chronic neuropathic pain was associated with motor cortex disinhibition , suggesting impaired GABAergic neurotransmission related to some aspects of pain or to underlying sensory or motor disturbances . The analgesic effects produced by motor cortex stimulation could result , at least partly , from the restoration of defective intracortical inhibitory processes
Presentation of relative effects regarding pain will facilitate interpretation of treatment effects
OBJECTIVE Pain is a patient-important outcome , but current reporting in r and omized controlled trials and systematic review s is often suboptimal , impeding clinical interpretation and decision making .