Endogenous opioids mediate left dorsolateral prefrontal cortex rTMS-induced analgesia

Taylor, Joseph J.; Borckardt, Jeffrey J.; George, Mark S.

doi:10.1016/j.pain.2012.02.030

Cited by 112Transcranial Magnetic Stimulation StudiesPain Management and TreatmentPain Mechanisms and Treatments

Endogenous opioids mediate left dorsolateral prefrontal cortex rTMS-induced analgesia

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Taylor, Joseph J., Borckardt, Jeffrey J., George, Mark S.·2012·Pain

DOI 10.1016/j.pain.2012.02.030PMC PMC3530383

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Abstract

The concurrent rise of undertreated pain and opiate abuse poses a unique challenge to physicians and researchers alike. A focal, noninvasive form of brain stimulation called repetitive transcranial magnetic stimulation (rTMS) has been shown to produce acute and chronic analgesic effects when applied to dorsolateral prefrontal cortex (DLPFC), but the anatomical and pharmacological mechanisms by which prefrontal rTMS induces analgesia remain unclear. Data suggest that DLPFC mediates top-down analgesia via gain modulation of the supraspinal opioidergic circuit. This potential pathway might explain how prefrontal rTMS reduces pain. The purpose of this sham-controlled, double-blind, crossover study was to determine whether left DLPFC rTMS-induced analgesia was sensitive to μ-opioid blockade. Twenty-four healthy volunteers were randomized to receive real or sham TMS after either intravenous saline or naloxone pretreatment. Acute hot and cold pain via quantitative sensory testing and hot allodynia via block testing on capsaicin-treated skin were assessed at baseline and at 0, 20, and 40 minutes after TMS treatment. When compared to sham, real rTMS reduced hot pain and hot allodynia. Naloxone pretreatment significantly reduced the analgesic effects of real rTMS. These results demonstrate that left DLPFC rTMS-induced analgesia requires opioid activity and suggest that rTMS drives endogenous opioidergic pain relief in the human brain. Further studies with chronic dosing regimens of drugs that block or augment the actions of opiates are needed to determine whether TMS can augment opiates in chronic or postoperative pain management.

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This effect of repetitive transcranial magnetic stimulation on capsaicin pain occurs via an opioid-dependent mechanism, as it is blocked by naloxone.
“this effect has been shown to occur via an opioid-dependent mechanism (i.e., it is blocked by naloxone)97”
From The dorsolateral prefrontal cortex in acute and chronic pain (2017) · cites this paper as [97]

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Self-citation

Authors: Taylor, J. J., Borckardt, J. J., & George, M. S.
Affiliations: Medical University of South Carolina (US)
Corresponding author: Taylor, Joseph J.
ORCID: Taylor, Joseph J.
Borckardt, Jeffrey J.
George, Mark S.
Venue: Pain
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2012-06
Volume: 153
Issue: 6
Pages: 1219-1225
ISSN: 0304-3959 (ISSN-L)
DOI: 10.1016/j.pain.2012.02.030
PMC: PMC3530383
OpenAlex: W2038342992
Cited by: 112
References: 74
Citations by year: 2026: 8 · 2025: 6 · 2024: 5 · 2023: 8 · 2022: 6 · 2021: 6 · 2020: 7 · 2019: 6 · 2018: 11 · 2017: 8 · 2016: 6 · 2015: 14 · 2014: 11 · 2013: 8 · 2012: 2
FWCI: 5.63
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Pain (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: Medical University of South Carolina
National Institute on Drug Abuse (F30DA033748)
Topics: Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
Keywords: repetitive transcranial magnetic stimulation, dorsolateral prefrontal cortex, endogenous opioids, analgesia, naloxone, cold pain, allodynia, capsaicin, quantitative sensory testing, pain management
MeSH terms: Acute Disease, Adult, Analgesia, Female, Humans, Male, Pain, Prefrontal Cortex, Cross-Over Studies, Opioid Peptides, Transcranial Magnetic Stimulation, Young Adult

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Endogenous opioids mediate left dorsolateral prefrontal cortex rTMS-induced analgesia

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