Effects of multi-session intermittent theta burst stimulation on central neuropathic pain: A randomized controlled trial

Background Repetitive transcranial magnetic stimulation (rTMS) is one of the effective treatments for neuropathic pain. Little is known about the effects of multi-session theta burst stimulation, one of the new paradigms of rTMS. Objective The aim of this study was to investigate the effects of multi-session intermittent theta burst stimulation (iTBS) on central neuropathic pain, using evaluation tools specific to neuropathic pain. Methods Patients with central neuropathic pain diagnosed using Neuropathic Pain Special Interest Group guidelines were recruited. Thirty patients were randomly assigned to either a real or sham iTBS group. Each patient underwent 5 sessions of iTBS; before and after completion of the 5 sessions, participants were evaluated using the self-completed Leeds assessment of neuropathic symptoms and signs (S-LANSS), the numeric rating scale (NRS), the neuropathic pain symptom inventory (NPSI), and the neuropathic pain scale (NPS). Results S-LANSS, NRS, NPSI, and 3 of 4 NPS combination scores decreased significantly in the real iTBS group but not in the sham iTBS group. No adverse effects were reported during or after iTBS sessions. Conclusions Multi-session iTBS was associated with a significant decrease in neuropathic pain, indicating its effectiveness as a treatment for patients with central neuropathic pain.