pISSN 2005-9159
eISSN 2093-0569

Review Article

Korean J Pain 2023; 36(4): 408-424

Published online October 1, 2023 https://doi.org/10.3344/kjp.23220

Copyright © The Korean Pain Society.

Repetitive transcranial magnetic stimulation in central post-stroke pain: current status and future perspective

Riva Satya Radiansyah1 and Deby Wahyuning Hadi2

1Faculty of Medicine and Health, Institut Teknologi Sepuluh Nopember, Surabaya, Indonesia
2Department of Neurology, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

Correspondence to:Riva Satya Radiansyah
Faculty of Medicine and Health, Institut Teknologi Sepuluh Nopember, Jl. Teknik Kimia, Keputih, Sukolilo, Surabaya 60111, East Jawa, Indonesia
Tel: +62-81-654-163-32, Fax: +6231-5994251, E-mail: riva.satya@its.ac.id

Handling Editor: Kyung-Joon Lim

Received: July 25, 2023; Revised: September 3, 2023; Accepted: September 14, 2023

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Central post-stroke pain (CPSP) is an incapacitating disorder that impacts a substantial proportion of stroke survivors and can diminish their quality of life. Conventional therapies for CPSP, including tricyclic antidepressants, anticonvulsants, and opioids, are frequently ineffective, necessitating the investigation of alternative therapeutic strategies. Repetitive transcranial magnetic stimulation (rTMS) is now recognized as a promising noninvasive pain management method for CPSP. rTMS modulates neural activity through the administration of magnetic pulses to specific cortical regions. Trials analyzing the effects of rTMS on CPSP have generated various outcomes, but the evidence suggests possible analgesic benefits. In CPSP and other neuropathic pain conditions, high-frequency rTMS targeting the primary motor cortex (M1) with figure-eight coils has demonstrated significant pain alleviation. Due to its associaton with analgesic benefits, M1 is the most frequently targeted area. The duration and frequency of rTMS sessions, as well as the stimulation intensity, have been studied in an effort to optimize treatment outcomes. The short-term pain relief effects of rTMS have been observed, but the long-term effects (> 3 months) require further investigation. Aspects such as stimulation frequency, location, and treatment period can influence the efficacy of rTMS and ought to be considered while planning the procedure. Standardized guidelines for using rTMS in CPSP would optimize therapy protocols and improve patient outcomes. This review article provides an up-to-date overview of the incidence, clinical characteristics, outcome of rTMS in CPSP patients, and future perspective in the field.

Keywords: Analgesics, Opioid, Central Post-Stroke Pain, Cerebral Cortex, Neuralgia, Pain, Pain, Intractable, Quality of Life, Stroke, Therapeutics, Transcranial Magnetic Stimulation.