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Pain trajectories of dorsomedial prefrontal intermittent theta burst stimulation versus sham treatment in depression

BACKGROUND: Prefrontal repetitive transcranial magnetic stimulation is an established add-on treatment for major depressive disorder and is increasingly feasible with protocols of short duration, such as intermittent theta burst stimulation (iTBS). The most common and limiting side effect is pain at...

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Autores principales: Malm, Erika, Struckmann, Wiebke, Persson, Jonas, Bodén, Robert
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7439669/
https://www.ncbi.nlm.nih.gov/pubmed/32819321
http://dx.doi.org/10.1186/s12883-020-01881-3
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author Malm, Erika
Struckmann, Wiebke
Persson, Jonas
Bodén, Robert
author_facet Malm, Erika
Struckmann, Wiebke
Persson, Jonas
Bodén, Robert
author_sort Malm, Erika
collection PubMed
description BACKGROUND: Prefrontal repetitive transcranial magnetic stimulation is an established add-on treatment for major depressive disorder and is increasingly feasible with protocols of short duration, such as intermittent theta burst stimulation (iTBS). The most common and limiting side effect is pain at the site of application. Our objective was to investigate how pain develops over time in patients with depression receiving iTBS compared to sham stimulation. METHODS: This is a subsample from a randomized clinical trial. Patients received daily sessions of 2400 pulses of dorsomedial prefrontal iTBS or sham stimulation with transcutaneous electric stimulation during 2 to 3 weeks. After unmasking of treatment allocation, patients receiving sham treatment were offered active iTBS in an open phase. Patients rated pain on a scale from 0 to 10 after the last train of stimulation on the first, fifth and final treatment day. A Mann-Whitney U-test was conducted to test for group differences and related-samples Friedman’s tests to analyze changes in pain ratings over time. RESULTS: The scalp pain in the group receiving iTBS was rated higher than sham treatment on the first (U = 263.5, p = 0.035) and fifth day (U = 271.0, p = 0.020) but not on the final day (U = 210.5, p = 0.121). The pain decreased mainly during the first 5 days of treatment (χ(2) = 0.875, p = 0.040). In the open phase the pain decreased from the first day to the final day (χ(2) = 1.194, p = 0.001). CONCLUSIONS: The subjective pain perception of active dorsomedial iTBS was higher than sham treatment but decreased over time, indicating an analgesic effect, or habituation. The result from this study can be used to inform patients about what to expect regarding pain during an iTBS treatment course. TRIAL REGISTRATION: Clinicaltrials.gov, NCT02905604. Registered 19 September 2016.
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spelling pubmed-74396692020-08-24 Pain trajectories of dorsomedial prefrontal intermittent theta burst stimulation versus sham treatment in depression Malm, Erika Struckmann, Wiebke Persson, Jonas Bodén, Robert BMC Neurol Research Article BACKGROUND: Prefrontal repetitive transcranial magnetic stimulation is an established add-on treatment for major depressive disorder and is increasingly feasible with protocols of short duration, such as intermittent theta burst stimulation (iTBS). The most common and limiting side effect is pain at the site of application. Our objective was to investigate how pain develops over time in patients with depression receiving iTBS compared to sham stimulation. METHODS: This is a subsample from a randomized clinical trial. Patients received daily sessions of 2400 pulses of dorsomedial prefrontal iTBS or sham stimulation with transcutaneous electric stimulation during 2 to 3 weeks. After unmasking of treatment allocation, patients receiving sham treatment were offered active iTBS in an open phase. Patients rated pain on a scale from 0 to 10 after the last train of stimulation on the first, fifth and final treatment day. A Mann-Whitney U-test was conducted to test for group differences and related-samples Friedman’s tests to analyze changes in pain ratings over time. RESULTS: The scalp pain in the group receiving iTBS was rated higher than sham treatment on the first (U = 263.5, p = 0.035) and fifth day (U = 271.0, p = 0.020) but not on the final day (U = 210.5, p = 0.121). The pain decreased mainly during the first 5 days of treatment (χ(2) = 0.875, p = 0.040). In the open phase the pain decreased from the first day to the final day (χ(2) = 1.194, p = 0.001). CONCLUSIONS: The subjective pain perception of active dorsomedial iTBS was higher than sham treatment but decreased over time, indicating an analgesic effect, or habituation. The result from this study can be used to inform patients about what to expect regarding pain during an iTBS treatment course. TRIAL REGISTRATION: Clinicaltrials.gov, NCT02905604. Registered 19 September 2016. BioMed Central 2020-08-20 /pmc/articles/PMC7439669/ /pubmed/32819321 http://dx.doi.org/10.1186/s12883-020-01881-3 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Malm, Erika
Struckmann, Wiebke
Persson, Jonas
Bodén, Robert
Pain trajectories of dorsomedial prefrontal intermittent theta burst stimulation versus sham treatment in depression
title Pain trajectories of dorsomedial prefrontal intermittent theta burst stimulation versus sham treatment in depression
title_full Pain trajectories of dorsomedial prefrontal intermittent theta burst stimulation versus sham treatment in depression
title_fullStr Pain trajectories of dorsomedial prefrontal intermittent theta burst stimulation versus sham treatment in depression
title_full_unstemmed Pain trajectories of dorsomedial prefrontal intermittent theta burst stimulation versus sham treatment in depression
title_short Pain trajectories of dorsomedial prefrontal intermittent theta burst stimulation versus sham treatment in depression
title_sort pain trajectories of dorsomedial prefrontal intermittent theta burst stimulation versus sham treatment in depression
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7439669/
https://www.ncbi.nlm.nih.gov/pubmed/32819321
http://dx.doi.org/10.1186/s12883-020-01881-3
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