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dc.contributor.authorTreister, Roien_US
dc.contributor.authorLang, Magdalenaen_US
dc.contributor.authorKlein, Max M.en_US
dc.contributor.authorOaklander, Anne Louiseen_US
dc.date.accessioned2014-03-11T02:48:51Z
dc.date.issued2013en_US
dc.identifier.citationTreister, Roi, Magdalena Lang, Max M. Klein, and Anne Louise Oaklander. 2013 . “Non-invasive Transcranial Magnetic Stimulation (TMS) of the Motor Cortex for Neuropathic Pain—At the Tipping Point?” Rambam Maimonides Medical Journal 4 (4): e0023. doi: 10.5041/RMMJ.10130 . http://dx.doi.org/ 10.5041/RMMJ.10130 .en
dc.identifier.issn2076-9172en
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:11879064
dc.description.abstractThe term “neuropathic pain” (NP) refers to chronic pain caused by illnesses or injuries that damage peripheral or central pain-sensing neural pathways to cause them to fire inappropriately and signal pain without cause. Neuropathic pain is common, complicating diabetes, shingles, HIV, and cancer. Medications are often ineffective or cause various adverse effects, so better approaches are needed. Half a century ago, electrical stimulation of specific brain regions (neuromodulation) was demonstrated to relieve refractory NP without distant effects, but the need for surgical electrode implantation limited use of deep brain stimulation. Next, electrodes applied to the dura outside the brain’s surface to stimulate the motor cortex were shown to relieve NP less invasively. Now, electromagnetic induction permits cortical neurons to be stimulated entirely non-invasively using transcranial magnetic stimulation (TMS). Repeated sessions of many TMS pulses (rTMS) can trigger neuronal plasticity to produce long-lasting therapeutic benefit. Repeated TMS already has US and European regulatory approval for treating refractory depression, and multiple small studies report efficacy for neuropathic pain. Recent improvements include “frameless stereotactic” neuronavigation systems, in which patients’ head MRIs allow TMS to be applied to precise underlying cortical targets, minimizing variability between sessions and patients, which may enhance efficacy. Transcranial magnetic stimulation appears poised for the larger trials necessary for regulatory approval of a NP indication. Since few clinicians are familiar with TMS, we review its theoretical basis and historical development, summarize the neuropathic pain trial results, and identify issues to resolve before large-scale clinical trials.en
dc.language.isoen_USen
dc.publisherRambam Health Care Campusen
dc.relation.isversionofdoi: 10.5041/RMMJ.10130en
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3820296/pdf/en
dash.licenseLAAen_US
dc.subjectSpecial Issue on Painen
dc.subjectChronic painen
dc.subjectclinical trialen
dc.subjectmotor cortexen
dc.subjectneuropathic painen
dc.subjecttranscranial magnetic stimulation (TMS)en
dc.titleNon-invasive Transcranial Magnetic Stimulation (TMS) of the Motor Cortex for Neuropathic Pain—At the Tipping Point?en
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden
dc.relation.journalRambam Maimonides Medical Journalen
dash.depositing.authorTreister, Roien_US
dc.date.available2014-03-11T02:48:51Z
dc.identifier.doi10.5041/RMMJ.10130*
dash.contributor.affiliatedLang, Magdalena
dash.contributor.affiliatedTreister, Roi
dash.contributor.affiliatedKlein, Max
dash.contributor.affiliatedOaklander, Anne


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