Transcraneal Magnetic Stimulation for Treatment of Non-nociceptive Pain in Chronic Diseases

Brief Summary

Background: Chronic non-nociceptive or nociplastic pain and neurological sequelae following stroke are associated with substantial functional impairment and reduced quality of life. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation technique capable of modulating cortical excitability and functional brain networks involved in pain processing and neurological recovery. However, its clinical response may vary according to the underlying phenotype and therapeutic target. Objective: To evaluate the safety, tolerability, and clinical response to rTMS as a complementary therapeutic intervention in patients with chronic non-nociceptive pain, fibromyalgia, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), Long COVID, and post-stroke sequelae, and to explore differences in treatment response across clinical conditions. Methods: A clinical study including baseline assessment, rTMS intervention, post-treatment evaluation, and follow-up was conducted. The protocol consisted of ten treatment sessions administered over two consecutive weeks. For chronic pain, fibromyalgia, ME/CFS, and Long COVID, excitatory stimulation at 10 Hz was delivered over the left primary motor cortex (M1), with 1,000 pulses per session. For post-stroke sequelae, inhibitory stimulation at 1 Hz with 600 pulses was applied according to the predominant clinical deficit. Target localization was performed using neuronavigation when individual magnetic resonance imaging was available and the international 10-20 system when it was not. Clinical outcomes included pain, fatigue, sleep, quality of life, motor function, and language performance, assessed using validated clinical scales.