Repetitive Transcranial Magnetic Stimulation for the Treatment of Complex Regional Pain Syndrome: A Pilot Study
Bibliographic record
Abstract
Stevie D Foglia,1 Chloe C Drapeau,2 Karishma R Ramdeo,2 Faith C Adams,2 Daniel B Soppitt,2 Ravjot S Rehsi,2 Harsha Shanthanna,1,3 Aimee J Nelson1,2 1School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada; 2Department of Kinesiology, McMaster University, Hamilton, ON, Canada; 3Department of Anesthesia, McMaster University, Hamilton, ON, CanadaCorrespondence: Aimee J Nelson, Department of Kinesiology, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada, Tel +1 905-525-9140 x28053, Fax +1 905-523-6011, Email nelsonaj@mcmaster.caPurpose: Complex regional pain syndrome (CRPS) is a debilitating chronic pain condition characterized by sensory, motor, and autonomic dysfunction with a world-wide prevalence of 26.2 per 100,000 people per year and is 3 to 4 times more prevalent in females. Repetitive transcranial magnetic stimulation (rTMS) has shown to be beneficial for pain relief in neuropathic pain and initial evidence in CRPS is promising, but studies are limited. The objective of this study was to investigate the feasibility of using rTMS in CRPS patients, to improve pain intensity and quality of life.Patients and Methods: Six participants (5 lower limb, 1 upper limb, 42 ± 9 yr) took part in an open-label rTMS study comprised of a 9-week intervention and 6-month follow-up. Participants took part in a 4-week induction period (5 days per week) followed by a 5-week tapering period whereby the frequency of rTMS sessions per week was reduced. rTMS was delivered at 10 hz for 2000 pulses at 80% of resting motor threshold over the primary motor cortex. Feasibility was assessed as compliance of attending treatment sessions. Clinical outcomes included pain intensity using the numerical ratings scale, Pain Catastrophizing scale-EN-SF, PROMIS-29 v2.0 profile, and Rainbow Pain Scale.Results: All participants tolerated the study procedures and 83% of participants completed the 9-week intervention, deeming the protocol feasible. At six months follow-up, data was obtained from 3 individuals. Exploratory analysis revealed a significant reduction in pain intensity (~20%) immediately following the intervention. Categorical improvements in allodynia were observed in four patients immediately following the intervention.Conclusion: This study demonstrates that rTMS delivered over 9 weeks is feasible and well tolerated in individuals living with CRPS. However, there are challenges in collecting follow-up data for six months and appropriate measures must be taken in randomized controlled trials to ensure follow-up retention.Keywords: complex regional pain syndrome, repetitive transcranial magnetic stimulation, neuromodulation, chronic pain, feasibility
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".