Targeted rTMS for Pain Relief

Stimulation was performed using a MagPro stimulator [MagVenture (distr. Mag2Health), Farum, Denmark] and either a flat B65 coil (MagVenture) in patients with upper limb pain or an angled B70 figure-of-eight coil (MagVenture) in patients with lower limb. Compared to flat figure-of-eight coils, the B70 coil is more powerful, leading to lower the resting motor threshold by 10–33%^{22 (link)} and stimulates deeper the motor cortex corresponding to lower limbs due to its angle of 150°.^{23 (link)}The motor cortical representation of the painful region was targeted using a TMS Navigator system, integrating individual brain MRI data (Localite, Sankt Augustin, Germany). Stimulation was performed at 10 Hz with an intensity set at 80% of the rest motor threshold (previously determined with motor evoked potential recording) and the coil held in posteroanterior orientation. Each rTMS session consisted of 40 trains of 5-s duration with inter-train interval of 25 s for a total of 2000 pulses in 20 min. This protocol is in line with the expert recommendations for safety.^{24 (link),25 (link)}