Objective: An open label pilot study designed to assess safety and efficacy of repetitive transcranial magnetic stimulation(rTMS) to treat pain in Parkinson’s Disease.

Background: Pain is a prevalent symptom in patients who suffer from Parkinson’s disease (PD). Pain management remains an unmet need. Current evidence for treatment of this disabling symptom is poor. Brain stimulation techniques have been used to address a variety of pain conditions commonly considered refractory to conventional therapy. rTMS is a non-invasive outpatient-based procedure that uses electromagnetic induction to regulate the activity of the complex cortical and subcortical networks involved in the processing of painful signals and possibly strengthening the endogenous descending pain modulation system. rTMS offers several theoretical advantages over pharmacological management of PD associated pain. It can be tailored to the patient’s condition, with stimulation targets chosen within primary motor cortex (M1) for best effect or moved to other cortical areas depending on the characteristics of pain. Clinically symptomatic improvement may occur concomitantly with changes in pain levels. rTMS has no effect on autonomic functions avoiding the common side effects associated with drug therapy. Most adverse effects are normally transient and hardly ever lead to the patient discontinuing the treatment.

Methods: The study is an open label pilot study with the aim to recruit ten patients with refractory pain in Parkinson’s Disease. Each patient will receive ten sessions of targeted rTMS with close monitoring of their motor and non-motor Parkinson’s disease symptoms including their pain scores and quality of life scores. The stimulation sessions will occur over a maximum period of eight weeks.

Results: The study is underway. We will present safety and efficacy results of using this method to treat pain in Parkinson’s Disease.

Conclusions: Further research is required on the efficacy of rTMS and whether it is a viable clinical tool to treat PD associated pain. We aim to use the results of this study to guide the design of a randomised controlled clinical trial of sham rTMS versus rTMS in the future.

References: Jin, Y., et al., High Frequency Repetitive Transcranial Magnetic Stimulation Therapy For Chronic Neuropathic Pain: A Meta-analysis. Pain Physician, 2015. 18(6): p. E1029-46. Politis, M., et al., Parkinson’s disease symptoms: the patient’s perspective. Mov Disord, 2010. 25(11): p. 1646-51.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/is-repetitive-transcranial-magnetic-stimulation-an-effective-tool-to-treat-pain-in-parkinsons-disease/