| Paper Authors: | Afifa Humaira, Sihaoyu Gao, Elizabeth Gregory, Lisa Ridgway, Daniel Blumberger, Jonathan Downar, Zafiris Daskalakis, Nicholas Ainsworth, Lang Wu, Micheal Butterfield, Fidel Vila-Rodriguez |
| Post Author(s): | Afifa Humaira, Elizabeth Gregory, Alice Erchov, Sarah Kessler |
| Download the research article: | C Humaira et al_2021_A patient-oriented analysis of pain side effect |
Introduction
The symptoms of depression are bad enough without enduring side effects from the medications used to treat them. Newer treatments without drugs include repetitive transcranial magnetic stimulation (rTMS), a non-invasive procedure where patients receive a series of short magnetic pulses over the scalp to stimulate the nerve cells of the brain. Daily 40-minute treatments using a protocol called high-frequency stimulation (HF) are delivered for 6 weeks, however this can be shortened to daily 3-minute treatments using a protocol called intermittent theta burst stimulation (iTBS).
Methods
This paper studies the most common side effect of rTMS reported by patients, which is pain at the site of rTMS delivery. Pain was rated on a scale of 1-10 by patients, with 1 being no pain, and 10 being a great deal of pain. This paper demonstrates that pain is moderate at the start of treatment, typically rated as roughly 5 at the first treatment. Pain ratings reduce rapidly over the course of the six-week treatment period, and are typically rated as between 2-3 at the final treatment. There are 4 different courses of change that pain ratings can take over the 6 weeks of treatment:
Results
- 46% of patients report low pain throughout their treatment
- 21% of patients report higher pain initially, which quickly decreases significantly within the first week of treatment
- 19% of patients report higher pain initially, which decreases significantly after about 3 weeks of treatment
- 13% of patients report higher pain which decreases only a little with each week of treatment
A few factors can influence pain ratings. 3 minute treatments (iTBS) are typically reported as more painful than 40 minute treatments (HF stimulation). Higher treatment dosages (determined based on physiology) tend to be more painful. Finally, patients who are older, female, and/or who report higher levels of anxiety, may experience higher levels of pain. The vast majority of patients are able to complete a course of rTMS, and pain during stimulation is rarely a reason to stop treatments.
Conclusion
Most patients report low pain during rTMS, and those that experience more pain tend to notice a significant decrease in pain throughout their treatments. Knowing this will help patients to make an informed choice when deciding to enter rTMS treatment.