Work

Higher Pretreatment Evoked Alpha-Band Oscillatory Brain Dynamics Predict Chronic Pain Reduction of Noninvasive Brain Stimulation of Nonmotor Targets

Year: 2026

Type: article

Abstract: OBJECTIVES: Repetitive transcranial magnetic stimulation (TMS; rTMS) of nonmotor cortical targets, including the left dorsolateral prefrontal cortex (DLPFC), anterior cingulate cortex (ACC), and posterosuperior insula (PSI), has been proposed as a treatment for chronic pain with variable clinical outcomes. Previous work identified pretreatment cortical excitability and oscillatory dynamics, assessed using the combination of TMS and electroencephalography (TMS-EEG), that were associated with treatment response after primary motor cortex stimulation. In this secondary analysis of a large clinical trial, it was evaluated whether responders to rTMS delivered to these nonmotor targets exhibited distinct pretreatment TMS-evoked cortical responses compared with nonresponders. MATERIALS AND METHODS: A total of 45 patients with chronic pain received 12 sessions over 8 weeks of 10 Hz rTMS to DLPFC, ACC or PSI. Pretreatment cortical responses were assessed using TMS-EEG at each of the 3 targets. Cortical reactivity was quantified using global and local mean field power, and oscillatory dynamics were assessed using event-related spectral perturbation (ERSP) and intertrial coherence (ITC) in the alpha-band (8-12 Hz). RESULTS: Responders (20 of 45, 44%) compared with nonresponders showed higher pretreatment alpha-band ERSP and ITC over the stimulated cortical targets (both p < 0.05), and higher alpha-band ERSP and ITC values were negatively correlated with the percentage change in pain intensity (both p < 0.05). These results suggest that elevated pretreatment TMS-evoked alpha-band oscillatory activity may indicate a higher probability of pain reduction to nonmotor rTMS in chronic pain. CONCLUSIONS: This study supports the development of enrichment strategies using cortical neurophysiology-based markers in neuromodulation trials aimed at individualized, precision-oriented treatments.

Source: Neuromodulation Technology at the Neural Interface

DOI: 10.1016/j.neurom.2026.03.017