Combination of Repetitive Transcranial Magnetic Stimulation on the left Dorsolateral Prefrontal Cortex with Repetitive Peripheral Magnetic Stimulation Reduces Pain Scale in Patients with Chronic Low Back Pain

  • Rauly Rahmadhani alauddin university
  • Andi Kurnia Bintang Departemen Neurologi,Universitas Hasanuddin Makassar
  • Andi Weri Sompa Departemen Neurologi,Universitas Muhammadiyah Makassar
  • Rina Masadah Departemen Patologi Anatomi,Universitas Hasanuddin Makassar
Keywords: Chronic Low Back Pain, repetitive Transcranial Magnetic Stimulation (rTMS), repetitive Peripheral Magnetic Stimulation (rPMS)


Prevalence of chronic low back pain (CLBP) is still high, there is no effective pharmacological treatment with minimal side effects when consumed in the long term, while the treatment of CLBP generally requires long-term pain treatment. This study aims to assess the effect of a combination of repetitive Transcranial Magnetic Stimulation (rTMS) and repetitive Peripheral Magnetic Stimualtion (rPMS) on pain scale changes in patients with CLBP. This is an experimental study using consecutive sampling which is divided randomly into two groups. The treatment group received pharmacology treatment and combination of rTMS and rPMS for two weeks, the control group was only given pharmacology treatment. Pain was measured in both groups on the first, sixth, and thirteenth days. The results showed that there was a significant difference in pain reduction between the treatment group and the control group. The decrease in pain scale in the treatment group was much greater with a mean value of -6.07 compared to the control group with a value of -3.00, significant with a p value of 0.001. Conclusion: After 10 intervention sessions the combination of rTMS and rPMS had an effect on reducing the pain scale in patients with chronic low back pain.


Freigang S, Lehner C, Fresnoza SM, Mahdy Ali K, Hlavka E, Eitler A, et al. Comparing the Impact of Multi-Session Left Dorsolateral Prefrontal and Primary Motor Cortex Neuronavigated Repetitive Transcranial Magnetic Stimulation (nrTMS) on Chronic Pain Patients. Brain Sciences, 2021 Jul 22;11(8):961.

PERDOSSI. Panduan Praktis Klinis Neurologi. JAKARTA; 2016.

Chou R, Huffman LH. Medications for Acute and Chronic Low Back Pain: A Review of the Evidence for an American Pain Society/American College of Physicians Clinical Practice Guideline. Annals of Internal Medicine. 2007 Oct 2;147(7):505.

Marcum ZA, Hanlon JT. Recognizing the Risks of Chronic Nonsteroidal Anti-Inflammatory Drug Use in Older Adults. The Annals of Long-term Care: the official journal of the American Medical Directors Association, 2010;18(9):24-7.

Yang S, Chang MC. Effect of Repetitive Transcranial Magnetic Stimulation on Pain Management: A Systematic Narrative Review. Frontiers in Neurology, 2020 Feb 18;11:114.

Vielsmeier V, Schecklmann M, Schlee W, Kreuzer PM, Poeppl TB, Rupprecht R, et al. A Pilot Study of Peripheral Muscle Magnetic Stimulation as Add-on Treatment to Repetitive Transcranial Magnetic Stimulation in Chronic Tinnitus. Frontiers in Neuroscience, 2018 Feb 20;12:68.

Beam W, Borckardt JJ, Reeves ST, George MS. An efficient and accurate new method for locating the F3 position for prefrontal TMS applications. Brain Stimulation, 2009 Jan;2(1):50–4.

Rustin Berlow, Volcani D. Location of F3: Comparing Calculated (Beam F3 Method) to Empirical (6cm Method) for Optimal TMS Coil Placement (Dorsolateral Prefrontal Cortex) [poster]. 2015.

Ong WY, Stohler CS, Herr DR. Role of the Prefrontal Cortex in Pain Processing. Molecular Neurobiology, 2019 Feb;56(2):1137–66.

Seminowicz DA, Moayedi M. The Dorsolateral Prefrontal Cortex in Acute and Chronic Pain. The Journal of Pain, 2017 Sep;18(9):1027–35.

Apkarian VA, Hashmi JA, Baliki MN. Pain and the brain: Specificity and plasticity of the brain in clinical chronic pain. Pain, 2011 Mar;152(3):S49–64.

Moretti J, Poh EZ, Rodger J. rTMS-Induced Changes in Glutamatergic and Dopaminergic Systems: Relevance to Cocaine and Methamphetamine Use Disorders. Frontiers of Neuroscience, 2020 Mar 6;14:137.

Biernacki K, Myers CE, Cole S, Cavanagh JF, Baker TE. Causal effects of prefrontal transcranial magnetic stimulation on dopamine-mediated reinforcement learning in healthy adults. Biorxiv, 2022 Jun.

Lim YH, Song JM, Choi EH, Lee JW. Effects of Repetitive Peripheral Magnetic Stimulation on Patients With Acute Low Back Pain: A Pilot Study. Annals of Rehabilitation Medicine, 2018;42(2):229.

Altas EU, Askin A, Beşiroğlu L, Tosun A. Is high-frequency repetitive transcranial magnetic stimulation of the left primary motor cortex superior to the stimulation of the left dorsolateral prefrontal cortex in fibromyalgia syndrome?. Somatosensory and Motor Research, 2019 Jan 2;36(1):56–62.

Che X, Cash RFH, Luo X, Luo H, Lu X, Xu F, et al. High-frequency rTMS over the dorsolateral prefrontal cortex on chronic and provoked pain: A systematic review and meta-analysis. Brain Stimulation, 2021 Sep;14(5):1135–46.

Badawy RAB, Tarletti R, Mula M, Varrasi C, Cantello R. The routine circular coil is reliable in paired-TMS studies. Clinical Neurophysiology, 2011 Apr;122(4):784–8.

Ho Chae, Jeong, Kim, Won, Myong Bahk, Won. Repeated Transcranial magnetic Stimulation (rTMS) with Circular Coil for Patients with Treatment Resistant Depression; AN Open Trial. Psychiatry Investigation, 2005;2(1):61–5.

Massé-Alarie H, Beaulieu LD, Preuss R, Schneider C. Repetitive peripheral magnetic neurostimulation of multifidus muscles combined with motor training influences spine motor control and chronic low back pain. Clinical Neurophysiology, 2017 Mar;128(3):442–53.

Ambriz-Tututi M, Alvarado-Reynoso B, Drucker-Colín R. Analgesic effect of repetitive transcranial magnetic stimulation (rTMS) in patients with chronic low back pain: rTMS Effect in Patients With Low Back Pain. Bioelectromagnetics, 2016 Dec;37(8):527–35.

How to Cite
Rahmadhani, R., Andi Kurnia Bintang, Andi Weri Sompa, & Rina Masadah. (2023). Combination of Repetitive Transcranial Magnetic Stimulation on the left Dorsolateral Prefrontal Cortex with Repetitive Peripheral Magnetic Stimulation Reduces Pain Scale in Patients with Chronic Low Back Pain. Alami Journal (Alauddin Islamic Medical) Journal, 7(2), 58-66.
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