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Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Luis Garcia-Larrea, Lyon Neuroscience Research Centre, France
- Second opponent: Associate Professor Daniel Ciampi de Andrade, Aalborg University, Denmark
- Third member and chair of the evaluation committee: Professor Cecilie Røe, University of Oslo
Chair of the Defence
Professor II Erik Taubøll, University of Oslo
Principal Supervisor
Postdoc Sara Magelssen Vambheim, Oslo University Hospital
Summary
Neuropathic pain is pain that occurs due to a lesion or disease to the central or peripheral nervous system and can lead to sleep disturbances, anxiety, depression, and impaired cognitive functions. Typically, neuropathic pain is treated with pharmacological interventions, but many patients do not experience effective pain relief, and side effects are common.
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation technique that has shown to produce analgesic effects in chronic neuropathic pain patients when targeting the primary motor cortex. It has also shown to decrease symptoms of anxiety and depression and enhance cognitive functioning in other patient populations.
The aim of this thesis was to investigate the therapeutic effects of rTMS to the primary motor cortex in chronic central and peripheral neuropathic pain patients. Specifically, we investigated the analgesic and psychological effects of deep and superficial rTMS in central neuropathic pain patients, and the analgesic, psychological and cognitive effects of deep rTMS in peripheral neuropathic pain patients.
Both superficial and deep rTMS reduced pain intensity in patients with central neuropathic pain compared to placebo treatment. Deep rTMS also proved to reduce symptoms of anxiety and depression in those with peripheral neuropathic pain. However, the patients' cognitive functions remained unchanged.
The effects of pain and psychological outcomes after rTMS detected for superficial and deep rTMS were short-lasting, and future studies may benefit from longer treatment periods, for example with maintenance sessions for more enduring effects.
Further larger scale studies could investigate whether targeting prefrontal brain regions, which are associated with improved depression, anxiety and cognition, in addition to motor cortex stimulation could be beneficial to achieve psychological and cognitive effects as well as pain relief after rTMS.
Additional information
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