Comparing Three Motor Cortex rTMS Protocols for Treating Chronic Peripheral Neuropathic Pain in Adults

What this Trial Is About

Researchers are evaluating three different repetitive transcranial magnetic stimulation rTMS protocols to treat chronic neuropathic pain, a condition where drugs only relieve symptoms in about half of patients. This study compares the classical high-frequency rTMS CHF-rTMS, spaced high-frequency rTMS SHF-rTMS, and accelerated intermittent theta burst stimulation ACC-iTBS, which has not been previously tested for chronic pain. The goal is to understand how the number of pulses and sessions influences pain relief and to find a protocol that balances effectiveness and ease of use. The study randomly assigns 36 patients aged 18 to 80 with painful peripheral neuropathy to one of the three rTMS groups. All treatments target the primary motor cortex contralateral to pain at 80% of resting motor threshold using a figure-of-eight coil. CHF-rTMS delivers 3,000 pulses per session over 10 sessions in 7 weeks. SHF-rTMS delivers 1,600 pulses per session over 4 weekly sessions totaling 6,400 pulses. ACC-iTBS involves 20 sessions over 4 days with 1,500 pulses per session totaling 30,000 pulses. The sessions differ in frequency, duration, and intervals. Participants attend multiple visits including screening, inclusion, two full assessment visits with clinical questionnaires and neurophysiological tests EEG, TMS-EEG evoked potentials, and paired-pulse TMS, and a final visit. They keep a pain diary and undergo weekly follow-ups for 11 weeks to monitor pain intensity, impact, side effects, and global impression of change. The main outcome measured is the interference of pain with daily activities, assessed up to 5 weeks after treatment completion.

Protocol Assessment of Motor Cortex rTMS for Treating Neuropathic Pain