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, immediate post-extubation rTMS to the left DLPFC reduced chronic postsurgical pain at 3 months (24.3% vs 43.5%; RR 0.56) and improved anxiety and depression scores. Lower serum CXCL10 levels in the active group and strong predictive accuracy of CXCL10 for CPSP (AUC 0.90) suggest an inflammation-related mechanism.

Key Findings

• Active rTMS reduced 3-month CPSP incidence versus sham (24.3% vs 43.5%; RR 0.56; P = 0.002).
• rTMS improved anxiety and depression scores at 3 months relative to sham.
• Serum CXCL10 levels were lower with rTMS, and CXCL10 predicted CPSP well (AUC 0.90; cutoff 90.5 pg/mL).

Clinical Implications

rTMS could be integrated into perioperative pathways for older thoracic surgery patients as an adjuvant CPSP prevention strategy, with CXCL10 as a candidate risk-stratification biomarker. Multicenter replication and longer follow-up are needed before guideline adoption.

Limitations

• Single-center design with 3-month follow-up limits generalizability and long-term inference.
• Biomarker findings are exploratory; causal pathways require mechanistic validation.

Future Directions

Conduct multicenter, longer-term trials to confirm efficacy, optimize stimulation protocols, assess cost-effectiveness, and validate CXCL10-guided patient selection.