Neuromodulation in Patients With Neuropathic Pain and Depression: a Cross-over Study Between Two Targets in Transcranial Magnetic Stimulation, the Primary Motor Cortex and the Dorsolateral Prefrontal Cortex.
High-frequency repetitive transcranial magnetic stimulation of the primary motor cortex has shown its effect on refractory neuropathic pain, and rTMS of the dorsolateral prefrontal cortex is commonly used for treatment-resistant depression. The treatment for patients suffering from neuropathic pain and depression, concomitantly, still needs to be studied, as there are some specificities in both symptoms and brain functional MRI.
• Central or peripheral neuropathic pain
• Chronic pain (present for more than 6 months) with intensity greater than or equal to 4/10 on the numerical scale
• Pain present on a daily or near-daily basis (at least 4 days a week)
• Patient not completely relieved by recommended drug treatments for first- and second-line neuropathic pain
• Stable analgesic treatment (no new treatment or dosage adjustment) for at least one month, and will not need to be modified for the duration of the study.
• Patient with a depressive episode characterized according to DSM V criteria
• Indication for motor cortex rTMS by a neurologist
• Patient can be followed for the entire duration of the study
• Patient having received informed consent to participate in the study, and having co-signed a consent form with the investigator
• Member or beneficiary of a social security scheme