Early repetitive transcranial magnetic stimulation for preventing chronic postoperative pain in older adults: a randomized clinical sub-study.

Summary

In older adults undergoing thoracoscopic surgery, a single early postoperative rTMS session targeting the DLPFC reduced 3‑month CPSP (24.3% vs 43.5%; RR 0.56) and improved anxiety and depression scores. Serum CXCL10 levels were lower with active rTMS and showed strong predictive accuracy for CPSP (AUC 0.90), suggesting an inflammation-linked mechanism.

Key Findings

• Active rTMS reduced CPSP incidence at 3 months (24.3% vs 43.5%; RR 0.56; 95% CI 0.39–0.80; P=0.002).
• Anxiety and depression scores were significantly improved at 3 months with rTMS.
• Serum CXCL10 levels were lower in the rTMS group and showed strong predictive accuracy for CPSP (AUC 0.90; cutoff 90.5 pg/mL).

Clinical Implications

Early postoperative rTMS could be considered as an adjunct to multimodal analgesia to reduce CPSP in high-risk thoracoscopic surgery patients. CXCL10 may aid in risk stratification and treatment targeting, pending replication and protocol optimization.

Limitations

• Single-center sub-study with 3-month follow-up; long-term durability and generalizability are uncertain.
• Optimal dosing, session number, and target parameters were not explored.

Future Directions

Multicenter RCTs to confirm effectiveness, define optimal rTMS protocols and dosing schedules, and evaluate biomarker-guided patient selection for CPSP prevention.