Prolonged Continuous Theta Burst Stimulation With Transcranial Magnetic Stimulation Analgesic Effects and Corticospinal Excitability in Chronic Neuropathic Pain: A Randomized Clinical Trial
Authors' conclusion
This study demonstrates that pcTBS applied to M1 is an effective treatment for chronic neuropathic pain, with analgesic efficacy comparable to conventional 10-Hz rTMS.
Study context
- Population
- Participants with chronic neuropathic pain
- Participants
- 94 participants
- Comparison
- Prolonged continuous theta burst stimulation (pcTBS) vs 10-Hz repetitive transcranial magnetic stimulation (rTMS) vs sham stimulation over left M1 for 5 days
- Primary endpoint
- Analgesic efficacy of 5 days of M1 stimulation (pain vs baseline)
Methodological detailssham-controlled, double-blind
- Sham-controlled
- Double-blind
Primary result
As reported in the abstract
Pain after 5 days of M1 stimulation vs baseline
| Group | Value | Baseline mean ± SD | P vs baseline |
|---|---|---|---|
| 10-Hz | mean 37.9 (SD 17.5) | 48.5 ± 16.0 | P < .001 |
| pcTBS | mean 35.1 (SD 15.3) | 47.1 ± 15.1 | P < .001 |
Value
10-Hzmean 37.9 (SD 17.5)
pcTBSmean 35.1 (SD 15.3)
Baseline mean ± SD
10-Hz48.5 ± 16.0
pcTBS47.1 ± 15.1
P vs baseline
10-HzP < .001
pcTBSP < .001
- pcTBS vs 10-Hz: P = 0.16 — active groups did not differ
Further findings
Mean
| Outcome | pcTBS | 10-Hz | Sham | P value |
|---|---|---|---|---|
| Corticospinal excitability: MEPpcTBS vs Sham | 188.5 (SD 39.8) | 115.7 (SD 9.3) | 102.2 (SD 6.9) | P = 0.044 |
| Corticospinal excitability: MEP10-Hz vs Sham | Pcorrected = 1.000 | |||
| Corticospinal excitability: CSPpcTBS vs Sham | 113.9 (SD 3.8) | 103.6 (SD 2.9) | 101.7 (SD 3.3) | P = 0.039 |
| Corticospinal excitability: CSP10-Hz vs Sham | Pcorrected = 1.000 |
Pain in responders with maintenance sessions (part 2), Post2 vs Post1
- Post2 vs Post1: 21.3 ± 2.1 vs 27.1 ± 2.3
- P = 0.006
- Follow-up vs Post1 (analgesia maintained 1 month): 29.9 ± 2.7 vs 27.1 ± 2.3
- P = 0.74
- Increased corticospinal excitability associated with less pain at follow-up, r = −0.48
- P = 0.037
Pain symptoms in initial nonresponders, left dorsolateral prefrontal cortex (DLPFC) stimulation (part 3), post vs pre
- pcTBS: 11.3 ± 5.5 vs 13.1 ± 5.3
- P = 0.020
- 10-Hz rTMS: 15.9 ± 7.2 vs 15.5 ± 6.4
- P = 0.978
Original publication
Prolonged Continuous Theta Burst Stimulation With Transcranial Magnetic Stimulation Analgesic Effects and Corticospinal Excitability in Chronic Neuropathic Pain: A Randomized Clinical Trial. Anesth Analg. Published 24 August 2026. doi:10.
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