Review Article

The Contribution of Endogenous Modulatory Systems to TMS- and tDCS-Induced Analgesia: Evidence from PET Studies

Table 3

A summary of the main findings of the studies investigating the effects of TMS on the glutamatergic system.

Glutamatergic system
StudyDesignPopulation (n)InterventionResult

Fregni et al., 2011Crossover randomized double-blind placebo-controlled studyChronic pancreatitis/visceral pain

Sham group: 8
Real group: 9
Ten sessions of real or sham rTMS of SII
spectroscopy evaluation.
No significant changes in glutamate and N-acetyl aspartate (NAA) levels for either left or right SII-rTMS in the sham group
Significant increases in glutamate and NAA levels in the active group

De Andrade et al., 2013Crossover randomized double-blind placebo-controlled studyHealthy volunteers.
Active rTMS of the right M1; active rTMS of the right DLPFC/PMC; or sham, after either intravenous saline or ketamine pretreatmentKetamine significantly decreased the analgesic effects of both M1- and DLPFC/PMC-TMS

Wischnewski et al., 2018Clinical studyHealthy volunteers.
20 Hz beta tACS to M1, after intake of dextromethorphan (DMO) or placebo.Motor evoked potential significantly increased after tACS in placebo group compared with baseline. However, this effect was not found in the DMO group. Resting-state beta oscillatory activity increases when compared to baseline in the placebo group, but not in the DMO group