Combining Pulsed Radiofrequency With Transcranial Magnetic Stimulation to Manage Hemiplegic Shoulder Pain and Somatosensory Nerve Transmissions.

BACKGROUND

Hemiplegic shoulder pain (HSP) is a major cause of disability that is still challenging to manage in clinical practices. Both pulsed radiofrequency (PRF) and repetitive transcranial magnetic stimulation (rTMS) could reduce poststroke HSP to certain extents. However, it remains unknown whether combined PRF and rTMS treatment could increase analgesic efficacy for poststroke HSP.

OBJECTIVES

To evaluate the therapeutic efficacy of combined PRF and transcranial magnetic stimulation in treating HSP.

STUDY

DESIGN

This was a randomized, assessor-blinded pilot study.

SETTING

The rehabilitation department of a single hospital.

METHODS

In this pilot study, a 3-arm study design was utilized to compare the treatment efficacy of combined PRF and rTMS treatment with a single PRF or rTMS strategy. Patients were randomly assigned to receive PRF, rTMS, or combined treatment. Outcomes assessments included pain intensity, motor activity, and neurophysiological activities.

RESULTS

Our data indicated that rTMS acted more efficiently to reduce pain than PRF treatment. Combined treatment had a larger long-term efficacy than rTMS treatment alone. Both combined and single treatment improved motor recovery and neural transmissions, such as suprascapular nerve amplitude and somatosensory N20.

LIMITATIONS: As we designed a pilot study, the sample size was small in each treatment arm. Our findings thus need to be validated in future large studies.

CONCLUSION(S): These novel findings provide a safe and effective treatment strategy for poststroke HSP by combining PRF with rTMS treatment.

TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR2500100181.