Case report: The feasibility of rTMS with intrathecal baclofen pump for the treatment of unresolved neuropathic pain following spinal cord injury.
Stevie D Foglia, Ravjot S Rehsi, Claudia V Turco and 2 others
PMID 36188893WHAT IT FOUND
A man with spinal cord injury neuropathic pain reported lower pain scores during repeated magnetic brain stimulation, especially electrical attacks.
Pain returned during follow-up, and weekly top-up sessions did not restore relief.
Key findings
01During the 6-week treatment, the neuropathic pain scale score fell from 56/100 to 35/100, a reported 38% decrease, and electrical pain attacks stopped after the third week.
02Pain relief was not sustained: during follow-up the neuropathic pain scale score rose 34% from 35/100 to 47/100, and top-up sessions did not provide clinically important changes for sternum, buttock, or left foot pain.
03The intrathecal baclofen pump showed no function changes when interrogated before and after sessions during the monitored treatment period.
STILL TO COME
How it was doneWhat they found
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What it does not show
This is a case report, so it describes what happened to a single patient rather than showing that rTMS works. The patient continued several pain medicines during the study, so the effect of rTMS alone cannot be separated from those medicines. Pain and mood were self-reported, and depression and anxiety were not tracked during the follow-up period. A urinary tract infection occurred during follow-up and may have raised pain scores, so the length of pain relief after treatment is uncertain. Pump safety checks were done only during the treatment period, not during top-up sessions. Top-up sessions started after an untracked break and were not compared with a sham condition.
Declared interests
The authors declared no commercial or financial relationships that could be a conflict. The paper thanks the Canada Research Chairs program for financial support.
The easy way to misread this
Do not treat this as proof that magnetic brain stimulation relieves neuropathic pain or that it is safe for all people with an intrathecal baclofen pump. It describes a single patient, and the authors say larger sham-controlled studies are required.