Evaluation of the Effect of Repetitive Transcranial Magnetic Stimulation of Motor Cortex on Failed Back Surgery Syndrome Pain Control in the Short Term

Abstract

Background This study aimed to evaluate the short-term efficacy of repetitive transcranial magnetic stimulation (rTMS) on the treatment of failed back surgery syndrome (FBSS).

Methods In this prospective clinical trial study, 13 patients with FBSS were selected to undergo rTMS, including 5 sessions of stimulation of the primary motor cortex of 90 trains with a frequency of 10 Hz for 2 seconds and an intertrain interval of 20 seconds with a total pulse rate of 1800 per session. The time of each session was 30 minutes with an intensity of 80% of the motor threshold. The severity of pain before and after the intervention was measured by the short-form McGill Pain Questionnaire and visual analog scale (VAS).

Results The mean of pain severity was 26.54 ± 6.78 and 14.92 ± 10.1 before and after rTMS, respectively. The severity of pain was significantly decreased after the intervention (p = 0.001). According to the McGill Pain Questionnaire, the severity of pain in the patients was decreased by 44.09 ± 27.32. The mean of the severity of pain according to VAS was 77.31 ± 16.66 before rTMS and 53.46 ± 22.49 after rTMS, which showed that pain intensity was significantly decreased after the intervention (p = 0.006).

Conclusions The use of rTMS of the primary motor cortex in patients who have undergone lumbosacral spine surgery and suffer from pain related to FBSS is associated with a significant reduction in the severity of pain. Because rTMS is a noninvasive treatment method, it can be used as a suitable treatment in these patients.

Keywords

lumbosacral spine surgery - failed back surgery syndrome - repetitive transcranial magnetic stimulation

• References

• 1 Hoy D, March L, Brooks P. et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 2014; 73 (06) 968-974
• 2 Buyten JP, Linderoth B. “The failed back surgery syndrome”: definition and therapeutic algorithms—an update. Eur J Pain Suppl 2010; 4: 273-286
• 3 DePalma MJ, Ketchum JM, Saullo TR. Etiology of chronic low back pain in patients having undergone lumbar fusion. Pain Med 2011; 12 (05) 732-739
• 4 Farrokhi MR, Yadollahikhales G, Gholami M, Mousavi SR, Mesbahi AR, Asadi-Pooya AA. Clinical outcomes of posterolateral fusion vs. posterior lumbar interbody fusion in patients with lumbar spinal stenosis and degenerative instability. Pain Physician 2018; 21 (04) 383-406
• 5 Shapiro CM. The failed back surgery syndrome: pitfalls surrounding evaluation and treatment. Phys Med Rehabil Clin N Am 2014; 25 (02) 319-340
• 6 Farrokhi MR, Lotfi M, Masoudi MS, Gholami M. Effects of methylene blue on postoperative low-back pain and functional outcomes after lumbar open discectomy: a triple-blind, randomized placebo-controlled trial. J Neurosurg Spine 2016; 24 (01) 7-15
• 7 Thomson S, Jacques L. Demographic characteristics of patients with severe neuropathic pain secondary to failed back surgery syndrome. Pain Pract 2009; 9 (03) 206-215
• 8 Chan CW, Peng P. Failed back surgery syndrome. Pain Med 2011; 12 (04) 577-606
• 9 Taylor RS, Taylor RJ. The economic impact of failed back surgery syndrome. Br J Pain 2012; 6 (04) 174-181
• 10 Kim J, Ryu SB, Lee SE. et al. Motor cortex stimulation and neuropathic pain: how does motor cortex stimulation affect pain-signaling pathways?. J Neurosurg 2016; 124 (03) 866-876
• 11 Cruccu G, Aziz TZ, Garcia-Larrea L. et al. EFNS guidelines on neurostimulation therapy for neuropathic pain. Eur J Neurol 2007; 14 (09) 952-970
• 12 Defrin R, Grunhaus L, Zamir D, Zeilig G. The effect of a series of repetitive transcranial magnetic stimulations of the motor cortex on central pain after spinal cord injury. Arch Phys Med Rehabil 2007; 88 (12) 1574-1580
• 13 Ambriz-Tututi M, Alvarado-Reynoso B, Drucker-Colín R. Analgesic effect of repetitive transcranial magnetic stimulation (rTMS) in patients with chronic low back pain. Bioelectromagnetics 2016; 37 (08) 527-535
• 14 Farrokhi MR, Yazdanpanah H, Gholami M, Farrokhi F, Mesbahi AR. Pain and functional improvement effects of methylene blue injection on the soft tissue around fusion site after traumatic thoracolumbar fixation: A double-blind, randomized placebo-controlled study. Clin Neurol Neurosurg 2016; 150: 6-12
• 15 Farrokhi MR, Jamali M, Gholami M, Farrokhi F, Hosseini K. Clinical and radiological outcomes after decompression and posterior fusion in patients with degenerative scoliosis. Br J Neurosurg 2017; 31 (05) 514-525
• 16 Hosomi K, Shimokawa T, Ikoma K. et al. Daily repetitive transcranial magnetic stimulation of primary motor cortex for neuropathic pain: a randomized, multicenter, double-blind, crossover, sham-controlled trial. Pain 2013; 154 (07) 1065-1072
• 17 Bursali C, Özkan FÜ, Kaysin MY, Dortcan N, Aktas I, Külcü DG. Effectiveness of repetitive transcranial magnetic stimulation in patients with failed back surgery syndrome: a double-blind randomized placebo-controlled study. Pain Physician 2021; 24 (01) E23-E30
• 18 Nardone R, Höller Y, Langthaler PB. et al. rTMS of the prefrontal cortex has analgesic effects on neuropathic pain in subjects with spinal cord injury. Spinal Cord 2017; 55 (01) 20-25
• 19 Nardone R, Höller Y, Leis S. et al. Invasive and non-invasive brain stimulation for treatment of neuropathic pain in patients with spinal cord injury: a review. J Spinal Cord Med 2014; 37 (01) 19-31