Study of RTMS Analgesic Effect in Chronic Neuropathic Pain,

Randomized Double-blind Study of RTMS Analgesic Effect in Chronic Neuropathic Pain. Comparison Between Three Groups: Motor Cortex Stimulation by the Classic Coil B65, Deeper Stimulation by the Coil B70 and Placebo Stimulation. Analysis of Long-term RTMS-induced Brain Changes Using FMRI.

The purpose of this study is to compare the analgesic effectiveness of three modes of repetitive Transcranial Magnetic Stimulation (rTMS) in chronic neuropathic pain:

• Classical rTMS stimulation
• Deeper rTMS stimulation
• Sham rTMS stimulation

Conduct of study:

• Entry into the study: After informed consent, patients will be randomised. The physician responsible for conducting neurostimulation sessions will make the randomization via an interactive web response system (IWRS). Only this physician will have the knowledge of the group allocated to the patient.
• Baseline : Patients, will record on a diary form, a daily Visual Numeric Scale(VNS) of Pain Intensity for 1 week.
• Treatment sessions: after the baseline, sessions of neurostimulation will begin for seven weeks.
• After the end of neurostimulation sessions, patients will be followed for 2 weeks.
• Throughout their participation in the study, patients will plot on a diary form their daily VNS.

Inclusion Criteria:

• Patient's written consent
• Affiliated with social security system
• Male or female, suffering for more than a year from unilateral refractory neuropathic pain: hemi-body, upper limb, lower limb and facial chronic pain.
• Patient whose analgesic treatment, is stable for at least 1 month.
• Patient not responding to conventional treatments
• Prescreening EVN >3

Exclusion Criteria:

• History of drug addiction, epilepsy, cranial trauma
• History of psychiatric disorder
• Patients previously treated with rTMS
• Patient with intracranial ferromagnetic material or implanted stimulator
• New treatment for less than one month
• Pregnant or Breastfeeding woman
• Patient who does not understand the study protocol
• Persons who are protected under the act.