Transcranial magnetic stimulation attenuated neuropathic pain after spinal cord injury

Neuropathic pain imposes heavy physical, psychological and economic burdens on patients with spinal cord injury. However, the treatment of neuropathic pain after spinal cord injury remains a great obstacle. Noninvasive repetitive transcranial magnetic stimulation has been shown to improve neuropathic pain, but the mechanisms of transcranial magnetic stimulation intervention are not fully understood. In this research, we confirmed that transcranial magnetic stimulation improved spinal cord injury-induced neuropathic pain with a durative effect. We determined the optimal time and intensity of transcranial magnetic stimulation intervention, and confirmed that transcranial magnetic stimulation affected the functional connectivity of the brain, activated the hypothalamic pituitary adrenal axis, affected the gut microbiota, improved the inflammatory microenvironment in the spinal cord and increased the expression of glutamate transporters in the spinal cord. Thus, transcranial magnetic stimulation could improve neuropathic pain after spinal cord injury through multiple mechanisms, which may involve the hypothalamic pituitary adrenal axis axis and affect the gut microbiota.