Repetitive transcranial magnetic stimulation for chronic neuropathic pain in patients with bladder pain syndrome / interstitial cystitis

Journal: Neurourology and Urodynamics 1-10 (2018)

Authors: M Cervigni, E Onesti, M Ceccanti, M.C Gori, G Tartaglia, G Campagna, G Panico, L Vacca, C Cambieri, L Libonati, M Inghilleri


Pain is the main symptom of Bladder pain syndrome/interstitial cystitis (BPS/IC). It is neuropathic and perceived as violent pressure or a stabbing pain in thesuprapubic region causing a persistent discomfort thatincreases with bladder filling.No single therapy for BPS/IC currently exists.To date, the most commonapproach to neuropathic pain is the use of tricyclicantidepressants, opioids,topical lidocaine, and capsaicin patches.A number of rTMS-controlled studies have been conducted on patients with different neuropathicand non-neuropathic painsyndromes. However, no study has yet investigated rTMS as a treatment option for chronic neuropathic pain in BPS/IC.


To evaluate the efficacy, safety, and tolerability of rTMS associated with standard drug therapies for neuropathic pain that does not respond to pharmacological treatment alone inpatients with BPS/IC.


Fifteen patients with BPS/IC were enrolled in this randomized, double-blind, sham stimulation-controlled, crossover study. Patients were treated for 2 weeks with either real-rTMS (for five consecutive days in 20-min sessions) or sham-rTMS (for five consecutive days in 20-min sessions). After a 6-week washout period, the patients who had previously undergone real-rTMS underwent sham-rTMS, and vice versa. Patients were rated at each visit by means of questionnaires on pain, urinary disturbances, depression, and QOL.


The statistical analysis revealed significant effects of real-rTMS, when compared with sham-rTMS, on pain (in the VAS, Functional Neuropathic Pelvic Pain, Neuropathic Pain Symptom Inventory, McGill questionnaire, and Central Sensitization Inventory), urinary LUTS (in the Overactive Bladder Questionnaire score, bladder emptying, and daily urinary frequency), and QOL (in the subscores of the SF-36 related to physical pain and to emotional status). No serious adverse events were reported during the study.


The results of this study show that rTMS applied with an H-coil overthe M1 in the area corresponding to the pelvic region in patients with BPS/IC appears to improve chronic pelvic pain (CPP) and associated urinary disorders.

Read full article