Pilot Study of the Effectiveness of Repetitive Transcranial Magnetic Stimulation on Pain and Quality of Life in Patients with Chemotherapy-Induced Peripheral Neuropathic Pain

Estudio piloto de la eficacia de la estimulación magnética transcraneal repetitiva sobre el dolor y la calidad de vida en pacientes con dolor neuropático periférico inducido por quimioterapia


Background. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive technique that acts on the activity of the cerebral cortex employing electrical currents.

Aim. The objective of this project is to evaluate the effectiveness of rTMS on pain and quality of life in patients with chemotherapy-induced peripheral neuropathic pain.

Method. Ten patients with chemotherapy-induced peripheral neuropathic pain received 20 sessions of rTMS, consisting of 15 minutes of treatment repeated 5 times per week for four weeks (10 Hz, 20s, 30 trains with 81% intensity). Patients were evaluated using the Brief pain inventory (BPI) and the Functional Assessment of Cancer Therapy and neurotoxicity (FACT-GOG-NTX 13).

Results. There were significant differences in BPI mean severity, interference score and FACT-GOG-NTX 13 (p<0,05).

Conclusion. The pilot study results suggest that rTMS is potentially beneficial for the treatment of chemotherapy-induced peripheral neuropathy. rTMS over the M1 had an important reduction in pain severity, interference with daily activities, and quality of life scores. However, results should be taken with caution due to the small sample size, absence of a control group and short period of follow-up.


Download data is not yet available.

Citado por


Catalina Lopera-Muñeton
Silvia Betancur-Bedoya
Isabel Ángel
María Guadalupe Vásquez-Montoya
Sebastian Grajales-Toro
Dionis Vallejo


Hong P, Liu Y, Wan Y, Xiong H, Xu Y. Transcranial direct current stimulation for migraine: a systematic review and meta‐analysis of randomized controlled trials. CNS Neurosci Ther [Internet]. 2022;28(7): 992-8. doi: https://doi.org/10.1111/cns.13843 DOI: https://doi.org/10.1111/cns.13843

Lindholm P, Lamusuo S, Taiminen T, Pesonen U, Lahti A, Virtanen A, et al. Right secondary somatosensory cortex-a promising novel target for the treatment of drug-resistant neuropathic orofacial pain with repetitive transcranial magnetic stimulation. Pain [Internet]. 2015;156(7):1276-83. doi: https://doi.org/10.1097/j.pain.0000000000000175 DOI: https://doi.org/10.1097/j.pain.0000000000000175

Quesada C, Pommier B, Fauchon C, Bradley C, Créac'h C, Murat M, et al. New procedure of high-frequency repetitive transcranial magnetic stimulation for central neuropathic pain: a placebo-controlled randomized crossover study. Pain [Internet]. 2020;161(4):718-28. doi: https://doi.org/10.1097/j.pain.0000000000001760 DOI: https://doi.org/10.1097/j.pain.0000000000001760

Abdelkader AA, El Gohary AM, Mourad HS, El Salmawy DA. Repetitive TMS in treatment of resistant diabetic neuropathic pain. Egypt J Neurol Psychiatr Neurosurg [Internet]. 2019;55(1). doi: https://doi.org/10.1186/s41983-019-0075-x DOI: https://doi.org/10.1186/s41983-019-0075-x

Khedr EM, Kotb HI, Mostafa MG, Mohamad MF, Amr SA, Ahmed MA, et al. Repetitive transcranial magnetic stimulation in neuropathic pain secondary to malignancy: a randomized clinical trial. Eur J Pain [Internet]. 2015;19(4):519-27. doi: https://doi.org/10.1002/ejp.576 DOI: https://doi.org/10.1002/ejp.576

Hershman DL, Lacchetti C, Dworkin RH, Lavoie Smith EM, Bleeker J, Cavaletti G, et al. Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol [Internet]. 2014;32(18):1941-67. doi: https://doi.org/10.1200/JCO.2013.54.0914 DOI: https://doi.org/10.1200/JCO.2013.54.0914

Shkodra M, Caraceni A. Treatment of Neuropathic Pain Directly Due to Cancer: An Update. Cancers [Internet]. 2022;14(8). doi: https://doi.org/10.3390/cancers14081992 DOI: https://doi.org/10.3390/cancers14081992

Correa-Illanes G. Dolor neuropático, clasificación y estrategias de manejo para médicos generales. Revista Médica Clínica Las Condes [Internet]. 2014;25(2):189-99. doi: https://doi.org/10.1016/S0716-8640(14)70030-6 DOI: https://doi.org/10.1016/S0716-8640(14)70030-6

Yoon SY, Oh J. Neuropathic cancer pain: prevalence, pathophysiology, and management. Korean J Intern Med [Internet]. 2018;33(6):1058-69. doi: https://doi.org/10.3904/kjim.2018.162 DOI: https://doi.org/10.3904/kjim.2018.162

Swarm RA, Abernethy AP, Anghelescu DL, Benedetti C, Buga S, Cleeland C, et al. Adult Cancer Pain. J Natl Compr Canc Netw [Internet]. 2013;11(8):992-1022. doi: https://doi.org/10.6004/jnccn.2013.0119 DOI: https://doi.org/10.6004/jnccn.2013.0119

Aydede M. Defending the IASP Definition of Pain. Monist [Internet]. 2017;100(4):439-64. doi: https://doi.org/10.1093/monist/onx021 DOI: https://doi.org/10.1093/monist/onx021

Varona Sáez de Ibarra R. Mecanismos implicados en el desarrollo de Neuropatía periférica inducida por quimioterapia [undergraduate thesis]. Santander: Universidad de Cantabria; 2020. 45 p. Available from: https://repositorio.unican.es/xmlui/handle/10902/19486

Cruccu G, Truini A. A review of Neuropathic Pain: From Guidelines to Clinical Practice. Pain Ther [Internet]. 2017;6(Suppl 1):35-42. doi: https://doi.org/10.1007/s40122-017-0087-0 DOI: https://doi.org/10.1007/s40122-017-0087-0

Díaz Juvier YL, Hernández Ortega Y, Hernández Rodríguez LA, Cuevas Pérez OL, Fernández Ruiz DR. Tratamiento del dolor en el paciente oncológico. MediSur [Internet]. 2019;17(4):552-61. Available from: https://pesquisa.bvsalud.org/portal/resource/pt/biblio-1091206

Moisset X, Bouhassira D, Avez Conturier J, Alchaar H, Conradi S, Delmotte MH, et al. Pharmacological and non-pharmacological treatments for neuropathic pain: Systematic review and French recommendations. Rev Neurol (Paris) [Internet]. 2020;176(5):325-52. doi: https://doi.org/10.1016/j.neurol.2020.01.361 DOI: https://doi.org/10.1016/j.neurol.2020.01.361

Thouaye M, Yalcin I. Neuropathic pain: From actual pharmacological treatments to new therapeutic horizons. Pharmacology & Therapeutics [Internet]. 2023;251:108546. doi: https://doi.org/10.1016/j.pharmthera.2023.108546 DOI: https://doi.org/10.1016/j.pharmthera.2023.108546

Hosomi K, Sugiyama K, Nakamura Y, Shimokawa T, Oshino S, Goto Y, et al. A randomized controlled trial of 5 daily sessions and continuous trial of 4 weekly sessions of repetitive transcranial magnetic stimulation for neuropathic pain. Pain [Internet]. 2020;161(2):351-60. doi: https://doi.org/10.1097/j.pain.0000000000001712 DOI: https://doi.org/10.1097/j.pain.0000000000001712

Ströher Toledo R, Stein DJ, Stefani Sanches PR, da Silva LS, Richardt Medeiros H, Fregni F, et al. rTMS induces analgesia and modulates neuroinflammation and neuroplasticity in neuropathic pain model rats. Brain Research [Internet]. 2021;1762:147427. doi: https://doi.org/10.1016/j.brainres.2021.147427 DOI: https://doi.org/10.1016/j.brainres.2021.147427

Lefaucheur JP, Ayache SS, Sorel M, Farhat WH, Zouari HG, Ciampi de Andrade D, et al. Analgesic effects of repetitive transcranial magnetic stimulation of the motor cortex in neuropathic pain: influence of theta burst stimulation priming. Eur J Pain [Internet]. 2012;16(10):1403-13. doi: https://doi.org/10.1002/j.1532-2149.2012.00150.x DOI: https://doi.org/10.1002/j.1532-2149.2012.00150.x

Lefaucheur JP, Aleman A, Baeken C, Benninger DH, Brunelin J, Di Lazzaro V, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014-2018). Clin Neurophysiol [Internet]. 2020;131(2): 474-528. doi: https://doi.org/10.1016/j.clinph.2019.11.002 DOI: https://doi.org/10.1016/j.clinph.2020.02.003

Yang S, Chang MC. Effect of Repetitive Transcranial Magnetic Stimulation on Pain Management: A Systematic Narrative Review. Front Neurol [Internet]. 2020;11:1-19. doi: https://doi.org/10.3389/fneur.2020.00114 DOI: https://doi.org/10.3389/fneur.2020.00114

Goto Y, Hosomi K, Shimokawa T, Shimizu T, Yoshino K, Kim SJ, et al. Pilot study of repetitive transcranial magnetic stimulation in patients with chemotherapy-induced peripheral neuropathy. J Clin Neurosci [Internet]. 2020;73:101-7. doi: https://doi.org/10.1016/j.jocn.2020.01.020 DOI: https://doi.org/10.1016/j.jocn.2020.01.020

Clinical Trials Registration and Results Information Submission. 42 CFR Part 11. 2016. Federal Register Vol. 81, No. 183 (Sep 21, 2016). Available from: https://www.federalregister.gov/documents/2016/09/21/2016-22129/clinical-trials-registration-and-results-information-submission

Chan AW, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, Krle A-Jerić K, et al. Declaración SPIRIT 2013: definición de los elementos estándares del protocolo de un ensayo clínico. Rev Panam Salud Publica [Internet]. 2015;38(6):506-14. Available from: https://iris.paho.org/handle/10665.2/18567

World Medical Association. World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA [Internet]. 2013;310(20):2191-4. doi: https://doi.org/10.1001/jama.2013.281053 DOI: https://doi.org/10.1001/jama.2013.281053

National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE) V5.0. 2017 [Internet]. Estados Unidos: National Cancer Institute; 2017 [Updated 2021 Apr 19]. Available from: https://ctep.cancer.gov/protocoldevelopment/electronic_applications/ctc.htm#ctc_60

Mollica M, Newman SD. Breast cancer in African Americans: from patient to survivor. J Transcult Nurs [Internet]. 2014;25(4):334-40. doi: https://doi.org/10.1177/1043659614524248 DOI: https://doi.org/10.1177/1043659614524248

Beelen LM, van Dishoeck AM, Tsangaris E, Coriddi M, Dayan JH, Pusic AL, et al. Patient-Reported Outcome Measures in Lymphedema: A Systematic Review and COSMIN Analysis. Ann Surg Oncol [Internet]. 2021;28(3):1656-68. doi: https://doi.org/10.1245/s10434-020-09346-0 DOI: https://doi.org/10.1245/s10434-020-09346-0

Pommier B, Créac’h C, Beauvieux V, Nuti C, Vassal F, Peyron R, Robot-guided neuronavigated rTMS as an alternative therapy for central (neuropathic) pain: Clinical experience and long-term follow-up- Eur J Pain [Internet]. 2016;20(6):907-16. doi: https://doi.org/10.1002/ejp.815 DOI: https://doi.org/10.1002/ejp.815

Attal N, Poindessous-Jazat F, De Chauvigny E, Quesada C, Mhalla A, Ayache SS, et al. Repetitive transcranial magnetic stimulation for neuropathic pain: a randomized multicentre sham-controlled trial. Brain [Internet]. 2021;144(11):3328-39. doi: https://doi.org/10.1093/brain/awab208 DOI: https://doi.org/10.1093/brain/awab208

Nurmikko T, MacIver K, Bresnahan R, Hird E, Nelson A, Sacco P. Motor Cortex Reorganization and Repetitive Transcranial Magnetic Stimulation for Pain-A Methodological Study. Neuromodulation [Internet]. 2016;19(7):669-78. doi: https://doi.org/10.1111/ner.12444 DOI: https://doi.org/10.1111/ner.12444

Ma S-M, Ni J-X, Li X-Y, Yang L-Q, Guo Y-N, Tang Y-Z. High-Frequency Repetitive Transcranial Magnetic Stimulation Reduces Pain in Postherpetic Neuralgia. Pain Med [Internet]. 2015;16(11):2162-70. doi: https://doi.org/10.1111/pme.12832 DOI: https://doi.org/10.1111/pme.12832

Ayache SS, Ahdab R, Chalah MA, Farhat WH, Mylius V, Goujon C, et al. Analgesic effects of navigated motor cortex rTMS in patients with chronic neuropathic pain. Eur J Pain [Internet]. 2016;20(9):1413-22. doi: https://doi.org/10.1002/ejp.864 DOI: https://doi.org/10.1002/ejp.864

Lefaucheur JP. Cortical neurostimulation for neuropathic pain: state of the art and perspectives. Pain [Internet]. 2016;157(Suppl 1):S81-9. doi: https://doi.org/10.1097/j.pain.0000000000000401 DOI: https://doi.org/10.1097/j.pain.0000000000000401

Quesada C, Pommier B, Fauchon C, Bradley C, Créac’h C, Vassal F, et al. Robot-Guided Neuronavigated Repetitive Transcranial Magnetic Stimulation (rTMS) in Central Neuropathic Pain. Arch Phys Med Rehabil [Internet]. 2018;99(11):2203-15.e1. doi: https://doi.org/10.1016/j.apmr.2018.04.013 DOI: https://doi.org/10.1016/j.apmr.2018.04.013

Ratti MM, Gandaglia G, Sisca ES, Derevianko A, Alleva E, Beyer K, et al. A Systematic Review to Evaluate Patient-Reported Outcome Measures (PROMs) for Metastatic Prostate Cancer According to the COnsensus-Based Standard for the Selection of Health Measurement INstruments (COSMIN) Methodology. Cancers [Internet]. 2022;14(20):1-12. doi: https://doi.org/10.3390/cancers14205120 DOI: https://doi.org/10.3390/cancers14205120

Andersson V, Bergman S, Henoch I, Simonsson H, Ahlberg K. Benefits of using the Brief Pain Inventory in patients with cancer pain: an intervention study conducted in Swedish hospitals. Support Care Cancer [Internet]. 2020;28(8):3721-9. doi: https://doi.org/10.1007/s00520-019-05200-6 DOI: https://doi.org/10.1007/s00520-019-05200-6

Edirisinghe NP, Makuloluwa TR, Amarasekara TD, Goonewardena CSE. Evaluating psychometric properties of the Short Form Brief Pain Inventory Sinhala Version (SF BPI-Sin) among Sinhala speaking patients with cancer pain in Sri Lanka. BMC Psychol [Internet]. 2021;9(1):1-10. doi: https://doi.org/10.1186/s40359-021-00538-1 DOI: https://doi.org/10.1186/s40359-021-00538-1

Cheng HL, Lopez V, Ching Lam S, To Leung AK, Li YC, Hung Wong K, et al. Psychometric testing of the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group—Neurotoxicity (FACT/GOG-Ntx) subscale in a longitudinal study of cancer patients treated with chemotherapy. Health and Quality of Life Outcomes [Internet]. 2020;18(1):1-9. doi: https://doi.org/10.1186/s12955-020-01493-y DOI: https://doi.org/10.1186/s12955-020-01493-y

Sánchez-Pedraza R, Sierra-Matamoros FA, López-Daza DF. Validación colombiana de la escala FACT-B para medir la calidad de vida de pacientes con cáncer de mama. Rev colomb obstet ginecol [Internet]. 2012;63(3):196-206. doi: https://doi.org/10.18597/rcog.171 DOI: https://doi.org/10.18597/rcog.171

Seretny M, Currie GL, Sena ES, Ramnarine S, Grant R, MacLeod MR, et al. Incidence, prevalence, and predictors of chemotherapy-induced peripheral neuropathy: A systematic review and meta-analysis. Pain [Internet]. 2014;155(12):2461-70. doi: https://doi.org/10.1016/j.pain.2014.09.020 DOI: https://doi.org/10.1016/j.pain.2014.09.020

Hodaj H, Payen J-F, Hodaj E, Dumolard A, Maindet C, Cracowski J-L, et al. Long-term treatment of chronic orofacial, pudendal, and central neuropathic limb pain with repetitive transcranial magnetic stimulation of the motor cortex. Clin Neurophysiol [Internet]. 2020;131(7):1423-32. doi: https://doi.org/10.1016/j.clinph.2020.03.022 DOI: https://doi.org/10.1016/j.clinph.2020.03.022

Kim JK, Park HS, Bae JS, Jeong YS, Jung KJ, Lim JY. Effects of multi-session intermittent theta burst stimulation on central neuropathic pain: A randomized controlled trial. NeuroRehabilitation [Internet]. 2020;46(1):127-34. doi: https://doi.org/10.3233/NRE-192958 DOI: https://doi.org/10.3233/NRE-192958

Lawson McLean A, Frank S, Zafar N, Waschke A, Kalff R, Reichart R. Time course of the response to navigated repetitive transcranial magnetic stimulation at 10 Hz in chronic neuropathic pain. Neurol Res [Internet]. 2018;40(7):566-74. doi: https://doi.org/10.1080/01616412.2018.1453636 DOI: https://doi.org/10.1080/01616412.2018.1453636

Yin S, Njai R, Barker L, Siegel PZ, Liao Y. Summarizing health-related quality of life (HRQOL): development and testing of a one-factor model. Popul Health Metr [Internet]. 2016;14:1-9. doi: https://doi.org/10.1186/s12963-016-0091-3 DOI: https://doi.org/10.1186/s12963-016-0091-3

Cherif F, Zouari HG, Cherif W, Hadded M, Cheour M, Damak R. Depression Prevalence in Neuropathic Pain and Its Impact on the Quality of Life. Pain Res Manag [Internet]. 2020;2020. doi: https://doi.org/10.1155/2020/7408508 DOI: https://doi.org/10.1155/2020/7408508

Torrance N, Ferguson JA, Afolabi E, Bennett MI, Serpell MG, Dunn KM, et al., Neuropathic pain in the community: more under-treated than refractory? Pain [Internet]. 2013;154(5):690-9. doi: https://doi.org/10.1016/j.pain.2012.12.022 DOI: https://doi.org/10.1016/j.pain.2012.12.022

Zajączkowska R, Kocot-Kępska M, Leppert W, Wrzosek A, Mika J, Wordliczek J. Mechanisms of Chemotherapy-Induced Peripheral Neuropathy. Int J Mol Sci [Internet]. 2019;20(6):1-29. doi: https://doi.org/10.3390/ijms20061451 DOI: https://doi.org/10.3390/ijms20061451


Download data is not yet available.