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Chronic pain is a common issue worldwide and remains a big challenge to physicians, particularly when the underlying causes do not meet any specific disease for settlement. Such medically unexplained somatic symptoms of pain that lack an integrated diagnosis in medicine have a high psychiatric comorbidity such as depression, and will require a mult...
Contexts in source publication
Context 1
... 10 studies were found, including two case series (mostly unexpected findings in sham-controlled studies with depression as primary outcome measurement), 43,44 one controlled pilot study with CRPS as part of their research targets, 45 and seven controlled studies with chronic unexplained pain as primary research target. 46e52 The studies identified are summarized in Table 1. Most of these studies focused on patients with fibromyalgia or unexplained painful so- matic symptoms associated with major depression. ...
Context 2
... conclusion, findings from early case series and randomized sham-controlled rTMS study on fibromyalgia provided evidence to support analgesic effects of rTMS on chronic unexplained symp- toms of pain. Although the most optimal parameters warrant further research, existing evidence supports that high-frequency rTMS that target the left prefrontal cortex or the left primary Target Findings 2500 pulses/session, 10 sessions in 2 wks is effective in treating different aspects of pain (sensorye discriminative and emotionale affective) Active rTMS significantly reduced pain intensity from day 5 to week 25. These analgesic effects were associated with a long-term improvement in items related to quality of life. ...
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Citations
... Contralateral motor cortex is commonly targeted in patients with conversion disorders presenting with motor deficits (Schönfeldt-Lecuona et al., 2016). These studies suggest that TBS may be a potential treatment option for patients with somatoform disorder, particularly in reducing somatic symptoms and pain (Li et al., 2013). Existing evidences regarding beneficial role of transcranial magnetic stimulation in somatization disorder are highly heterogenous (Gonsalvez et al., 2021). ...
... [23] The underlying mechanism of prefrontal rTMS might consist of the release of endogenous opioids and modulation of the frontolimbic network. [24] Researchers have reported that low-frequency stimulation of DLPFC could significantly reduce pain and related symptoms by targeting spinal pain circuits and top-down modulation, [6] whereas high-frequency stimulation might achieve direct antinociceptive effects by activating descending pain inhibitory controls. [25] In this randomized, sham-controlled study, we found that both low-and high-frequency rTMS at DLPFC are effective and safe for the management of pain, depression, and anxiety, thereby improving the QoL in people with FMS. ...
Background and Objective
Fibromyalgia syndrome (FMS) is a chronic disease characterized by widespread, persistent musculoskeletal pain in association with impaired health-related quality of life. Repetitive transcranial magnetic stimulation (rTMS) is an emerging tool for the management of fibromyalgia. There is no standardized protocol of rTMS for the treatment of FMS, and both low- and high-frequency stimulation of the dorsolateral prefrontal cortex (DLPFC) are described in the literature with variable efficacy. The objective of this study was to determine the effectiveness of rTMS in people with fibromyalgia and compare the response of low- and high-frequency stimulation with sham stimulation.
Materials and Methods
This study was a single-blinded, randomized, placebo-controlled trial. Ninety patients with the diagnosis of FMS were randomly allocated into one of the following three groups: low-frequency (1 Hz) group, high-frequency (10 Hz) group, and sham group. Pain, depression, anxiety, and quality of life were measured using the Numerical Pain Rating Scale (NPRS), Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HDRS), and Revised Fibromyalgia Impact Questionnaire (FIQR) immediately following treatment as well as at 1 and 3 months after treatment. The data was statistically analyzed using Statistical Package for the Social Sciences version 23 software. P value < 0.05 was considered statistically significant.
Results
Intergroup analysis revealed a significant improvement in NPRS, HAM-A, HDRS, and FIQR scores in both low- and high- frequency groups immediately following treatment and for 3 months after treatment. No significant difference in the efficacy of low- and high-frequency stimulation was noticed.
Conclusions
rTMS is an effective mode of treatment in people with FMS. Both low and high frequencies of stimulation at DLPFC are equally effective in reducing pain and associated symptoms.
... Generally, persistent somatic symptom disorders remain inadequately researched, lacking substantial evidence on the efficacy of treatment modalities [7]. While there is limited data regarding the effectiveness of repetitive transcranial magnetic stimulation (rTMS) for treating persistent somatic symptom disorder, some evidence does exist regarding the utility of rTMS in addressing pain associated with depressive disorders and conditions like fibromyalgia or neuropathic pain [8]. ...
... We employed the Intermittent Theta Burst (iTBS) rTMS protocol, and it is noteworthy that the timeline of improvement closely mirrored that reported in trials for chronic pain associated with fibromyalgia [9]. While the exact mechanisms of action of rTMS remain unclear, it is postulated that processes such as endogenous opioid release, which contribute to functional improvements in brain regions associated with pain perception, may be involved [8]. An intriguing aspect of this case is that the patient reported substantial improvements before completing the full course of rTMS sessions. ...
... It is considered a huge burden of suffering and discomfort for patients that reduces the quality of life (QOL), causes social disability, reduces health care, and causes substantial social and economic costs (2). In addition to deteriorating QOL, the literature shows that long-term pain leads to comorbidity of mental and physical diseases (3). Despite numerous physical and psychological problems that patients with chronic pain face, researchers believe that adaptation to disease and its acceptance are essential in the disease treatment and can affect individuals' psychical and social conditions (4). ...
Background: Chronic pain is recognized as an important public health concern that leads to significant economic and social problems. Thus, identifying variables affecting the psychological adaptation of patients with chronic pain is necessary to prepare an effective intervention and treatment program. Objectives: This study investigated the mediating role of sexual self-esteem in the relationship between marital quality and psychological adaptation to disease in women with chronic pain. Methods: This descriptive-analytic study of correlation type was conducted on 200 women with chronic pain admitted to orthope-dic centers in Ardabil City, Iran. The participants were selected using the available sampling method. The Psychological Adaptation questionnaire, the Sexual Self-Esteem scale, and the Marital Relationship Quality questionnaire were used to collect data. The standard mean, standard deviation, Pearson correlation, and multiple regressions were used for data analysis. Results: The findings revealed significant positive relationships between marital quality (r = 0.49) (P < 0.01) and sexual self-esteem (r = 0.60) (P < 0.01) with psychological adaptation. Moreover, significant positive relationships were found between marital quality and sexual self-esteem (r = 0.48) (P < 0.01). Sexual self-esteem also mediated the relationship between marital quality and psychological adaptation (β = 0.23) (P < 0.01). Conclusions: The study revealed that sexual self-esteem served a fully mediating role between marital quality and psychological adaptation in women with chronic pain. Therefore, it is of utmost importance to pay attention to sexual self-esteem's role in therapeutic interventions related to these women.
... It is considered a huge burden of suffering and discomfort for patients that reduces the quality of life (QOL), causes social disability, reduces health care, and causes substantial social and economic costs (2). In addition to deteriorating QOL, the literature shows that long-term pain leads to comorbidity of mental and physical diseases (3). Despite numerous physical and psychological problems that patients with chronic pain face, researchers believe that adaptation to disease and its acceptance are essential in the disease treatment and can affect individuals' psychical and social conditions (4). ...
Abstract
Background: Chronic pain is recognized as an important public health concern that leads to significant economic and social problems. Thus, identifying variables affecting the psychological adaptation of patients with chronic pain is necessary to prepare an
effective intervention and treatment program.
Objectives: This study investigated the mediating role of sexual self-esteem in the relationship between marital quality and psychological adaptation to disease in women with chronic pain.
Methods: This descriptive-analytic study of correlation type was conducted on 200 women with chronic pain admitted to orthopedic centers in Ardabil City, Iran. The participants were selected using the available sampling method. The Psychological Adaptation
questionnaire, the Sexual Self-Esteem scale, and the Marital Relationship Quality questionnaire were used to collect data. The standard mean, standard deviation, Pearson correlation, and multiple regressions were used for data analysis.
Results: The findings revealed significant positive relationships between marital quality (r = 0.49) (P < 0.01) and sexual self-esteem
(r = 0.60) (P < 0.01) with psychological adaptation. Moreover, significant positive relationships were found between marital quality
and sexual self-esteem (r = 0.48) (P < 0.01). Sexual self-esteem also mediated the relationship between marital quality and psychological adaptation (β = 0.23) (P < 0.01).
Conclusions: The study revealed that sexual self-esteem served a fully mediating role between marital quality and psychological
adaptation in women with chronic pain. Therefore, it is of utmost importance to pay attention to sexual self-esteem’s role in therapeutic interventions related to these women.
Keywords: Sexual, Self-esteem, Marital Quality, Psychological Adaptation, Chronic Pain
... 36 Although there is a need for further research, the mechanisms of the analgesic effects of rTMS may involve improvement in the functioning within the DLPFC, anterior cingulate cortex, and sensory cortex, via enhancement of the endogenous opioid system. 37 In fact, it is difficult to explain exactly why there were no significant differences in the changes in depression level between the two groups in this study. This may be because the physical component of depression might be confounding in patients with severe physical diseases. ...
Background:
This study aimed to evaluate the therapeutic effect of repetitive transcranial magnetic stimulation (rTMS) as a nonpharmacologic treatment in depressed hemodialysis patients.
Methods:
Patients who scored ≥ 5 on the Patient Health Questionnaire-9 were randomized to either the rTMS (n = 7) or sham group (n = 7). The rTMS group was stimulated with a 110% motor threshold and 10 Hz on the left dorsolateral prefrontal cortex for 20 minutes, three times a week, for 4 weeks. In the sham group, the "1-wing 90-degree method" was used. We analyzed clinical indices before and after the intervention, as well as data from quantitative electroencephalography (frontal alpha asymmetry [FAA]), and various psychiatric questionnaires (Beck Depression Inventory-II, Beck Anxiety Inventory [BAI], Symptom Checklist-90-Revised Somatization Subscale [SCL-90R-SOM]), and Perceived Stress Scale.
Results:
One month after rTMS, the changes in hemoglobin A1c levels in the rTMS group were significantly greater than those in the sham group (F = 6.687, P = 0.032). The changes in BAI scores in the rTMS group were significantly greater than those in the sham group (F = 6.700, P = 0.025), and the changes in SCL-90R-SOM scores in the rTMS group were greater than those in the sham group (F = 4.943, P = 0.048). In addition, the changes in the FAA value at the F7 and F8 electrodes in the rTMS group were greater than those in the sham group (F = 6.468, P = 0.027).
Conclusion:
In depressed hemodialysis patients, rTMS may improve anxiety and somatization symptoms, which may lead to improvements in clinical measures. Trial Registration Clinical Research Information Service Identifier: KCT0004082.
... Chronic pain is a depressive condition, in which the person experiences not only the mental stress caused by the pain but also many other stressors that affect different parts of his life (2). Based on the existing research literature, long-term painful physical symptoms can lead to greater comorbidity of physical and mental illnesses, in addition to the quality of life deterioration (3). Chronic pain is one of the most common reasons adults seek medical care that has been linked to restrictions in mobility and daily activities, drug dependence, anxiety, and depression (4). ...
Background: The majority of patients living with chronic pain faces several challenges; therefore, factors affecting their adaptation to the disease to provide appropriate therapeutic methods and meditation and relaxation therapy should be identified. Objectives: The present study aimed at investigating the relationship between perceived burdensomeness and psychosocial adjustment, and the mediating role of pain self-efficacy. Methods: This descriptive correlational study was conducted on 240 patients with chronic pain referred to the orthopedic centers in Ardabil in 2019 selected by convenience sampling. Psychosocial Adjustment to Illness Scale, Pain Self-efficacy Questionnaire, and Interpersonal Needs Questionnaire were used for data collection. Also, Pearson correlation and multiple regressions were used for data analysis. Data were analyzed using SPSS V. 19 and AMOS V. 21. Results: The findings confirmed the negative and direct effect of perceived burdensomeness (β = -0.11 and P < 0.01), as well as the positive and direct effect of pain self-efficacy (β = 0.86 and P < 0.01) on psychosocial adjustment. On the other hand, perceived burdensomeness (β = -0.32, P < 0.01) had a negative and direct effect on pain self-efficacy. The indirect effect of perceived burdensomeness and pain self-efficacy on psychosocial adjustment to illness was also confirmed. Conclusions: According to the findings of the present study, it can be concluded that the feelings of pain self-efficacy mediate the relationship between perceived burdensomeness and psychosocial adjustment in patients with chronic pain. That can also be important for the patient and their caregivers in relation to other chronic illnesses. Chronic diseases can also affect patients and their caregivers.
... As routine practice, oral medication [3,4] and cognitive behavioral therapy [5] are recommended for treatment of OD patients. Recently, neuromodulation therapy has been clinically recommended for treating cognitive deficits in psychiatric disorders [64][65][66][67][68]. Our results in this study may suggest that prefrontal modulation in OD patients might be treated by using repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) in a dental clinic. ...
Objectives:
Neuropsychological associations can be considerable in occlusal dysesthesia (OD) patients who routinely complain of persistent occlusal discomfort, and somatization effects in the superior medial prefrontal cortex and the temporal and parietal regions are also present. However, the relationship between physical activity, i.e., chewing, prefrontal cognitive demand, and psychiatric states in OD patients remains unclear. We investigated this relationship in this study.
Materials and methods:
OD patients (n = 15) and healthy control (n = 15; HC) subjects were enrolled in this study. Occlusal contact, chewing activities of the masticatory muscles, prefrontal activities, and psychiatric states such as depression and somatization, of the participants were evaluated. Functional near-infrared spectroscopy was used to determine prefrontal hemodynamics and the Symptom Checklist-90-R was used to score the psychiatric states.
Results:
We observed a significant association between prefrontal deactivation during chewing and somatization subscales in OD patients. Further, there were no significant differences with regard to the occlusal state and chewing physical activities between the OD patients and HC subjects.
Conclusions:
Chewing-related prefrontal deactivation may be associated with somatization severity in OD patients.
Clinical relevance:
fNIRS is a functional imaging method that uses the principal of neuro-vascular couplings. It is applicable for evaluation of psychiatric state based on prefrontal cortex blood flow in patients with psychiatric disorders.
... 24 The underlying analgesic mechanisms of prefrontal rTMS may consist of the release of endogenous opioids 25 and modulation of the fronto-limbic network. 26 Meanwhile, prefrontal dysfunction has also been documented to be correlated with a core deficit in depression. 27,28 Furthermore, in real world scenarios, fibromyalgia patients often also struggle with depression, which has been shown to respond to rTMS treatment. ...
Aim
Fibromyalgia is often comorbid with depression, and less than half those patients achieve satisfactory improvement after adequate pharmacological intervention. The investigation of repetitive transcranial magnetic stimulation(rTMS) at left dorsolateral prefrontal cortex for modified‐2010 AmericanCollege of Rheumatology(ACR) fibromyalgia and major depressive disorder(MDD) is still in it’s infancy.
Methods
In this double‐blind, randomized, sham‐control study, subjects diagnosed with ACR‐2010 fibromyalgia and DSM‐IV‐TR MDD were recruited and received either active or sham interventions for two weeks. Hamilton Depression Rating Scale(HDRS) and the 10‐cm visual analogue pain scale were evaluated at baseline, week‐1,and week‐2. Multivariable generalized estimating equations(GEE) analysis was performed for the association between depression and pain scores at each checkpoint.
Results
Twenty subjects were recruited. Group difference was significant over twoweeksrTMS/sham stimulation(p=0.029), however, subgroup analyses were further performed due to significant interaction of group and HDRS on pain outcomes(p=0.020). The active group had significantly improvement on pain at week‐2 than week‐1(p=0.021); however control group didn't show any improvement on pain(p=0.585). Among mild to moderate depression patients, the pain score in the active group was significantly lower than sham group no matter at week‐1(p=0.001) or week‐2(p<0.001).For severe depression group, there was significantly lower pain over two weeks within active group(p=0.045) but sham group underwent significantly relapsing pain at week‐2(p<0.001).
Conclusion
We demonstrated the analgesic effect of left prefrontal rTMS in modified‐ACR 2010‐defined fibromyalgia and MDD patients and indicated the need of further investigation for adjusting different rTMS protocols according to the baseline depression severity in patients with fibromyalgia.
The trial is registered with UMIN‐CTR, registration number UMIN000023721.
This article is protected by copyright. All rights reserved.
... Both pharmacological and non-pharmacological options have been tried without much success and given the heterogeneity of clinical presentations, specific treatment guidelines are unavailable [7,8]. Whereas there is some evidence with respect to the effectiveness of rTMS in pain associated with depressive disorders and disorders such as fibromyalgia or neuropathic pain, to the best of our knowledge no such evidence exists for SPD [9]. Various mechanisms for the putative effectiveness of rTMS in such conditions have been postulated but the exact mechanisms remain unknown. ...
... The speed of improvement was similar to that has been reported in other trials for chronic pain due to fibromyalgia [10]. Thus similar mechanisms such as endogenous opioid release and functional improvements in brain areas associated with pain may be involved [9]. We also found that our patients reported a greater quantum of improvement than has been reported elsewhere. ...
Somatoform pain disorders (SPD) are common, disabling and do not respond well to existing treatment modalities. We investigated the usefulness of 18 sessions of high frequency repetitive transcranial magnetic stimulation delivered at the left dorsolateral prefrontal cortex (DLPFC) in five right-handed patients with SPD. All patients reported significant improvement in pain relief and activities of daily living. High-frequency repetitive transcranial magnetic stimulation (rTMS) delivered at the left DLPFC may be useful in SPD.
