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Effects of rTMS on chronic unexplained somatic symptoms of pain.

Effects of rTMS on chronic unexplained somatic symptoms of pain.

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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...

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... 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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... 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). ...
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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.
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... 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. ...
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... 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). ...
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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.
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... 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. ...
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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. ...
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... The rTMS has been used in the treatment of widespread pain since the 2000s. Previous reviews and guidelines on the topic have usually been favorable (le Marshall and Littlejohn, 2011;Li et al., 2013;Lefaucheur et al., 2014;Galhardoni et al., 2015). A quantitative assessment of this evidence has not been carried out. ...
... Previous reviews on the topic (le Marshall and Littlejohn, 2011; Li et al., 2013;Lefaucheur et al., 2014;Galhardoni et al., 2015) did not carry out a quantitative analysis of data and, therefore, yielded conclusions favorable to Fig. 4 Funnel plot of publication biaschange in pain severity (0-10 NRS) before and after the last stimulation. NRS, numeric rating scale. ...
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Even though repetitive transcranial magnetic stimulation (rTMS) has been used for a decade for the treatment of fibromyalgia, evidence of its effectiveness has not been definitely presented. The aim of this study was to investigate whether there is evidence of rTMS being effective in decreasing the severity of pain among patients with fibromyalgia. CENTRAL, MEDLINE, EMBASE, CINAHL, SCOPUS, WEB OF SCIENCE, and relevant references of the identified studies were searched. Randomized controlled studies on adults with fibromyalgia were included. The outcome studied was change in pain severity. Methodological quality was assessed using the scale introduced in the Guidelines for Systematic Reviews in the Cochrane Collaboration Back Review Group. A random-effects meta-analysis was carried out with a test for heterogeneity using the I and pooled estimate as a nonstandardized mean of difference in change in pain severity measures by a numeric rating scale. The search resulted in 791 records, eight relevant, and meta-analyses on seven trials. The risk of bias was considered low for seven studies. Pain severity before and after the last stimulation decreased by -1.2 points on 0-10 numeric rating scale (95% confidence interval: -1.7 to -0.8). Pain severity before and 1 week to 1 month after the last stimulation decreased by -0.7 points (95% confidence interval: -1.0 to -0.3). Both pooled results were below the minimal clinically important difference of 1.5 points. There is moderate evidence that rTMS is not more effective than sham in reducing the severity of pain in fibromyalgia patients, questioning the routine recommendation of this method for fibromyalgia treatment.
... The adverse effects of NBS are generally considered to be minor and well tolerated [1113], therefore studies have been conducted to explore the therapeutic applications of NBS in treating pathological conditions such as major depression, stroke, Parkinson disease, etc. [13,14]. As a neuromodulation technique, both rTMS and TDCS have been reported to have positive effects in treating neuropathic pain [11,12,1518]. However, previous meta-analysis investigated the effects of TDCS in treating clinical and experimental pain and found the level of evidence is still low [11]. ...
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Objectives: The effects of non-invasive brain stimulation (NBS), including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (TDCS), in treating FM remain inconclusive. The aim of this study was to investigate present evidence of using NBS as an add-on treatment in treating FM. Methods: We conducted a database search of the Medline, Embase, PsycINFO and Cochrane Library electronic databases, from inception to July 2015, to analyse randomized controlled trials of NBS in treating FM. A total of 16 studies were included in the current meta-analysis. Results: The pooled mean effect sizes of the 16 included studies revealed significant favourable effects of NBS. The weighted mean effect size in reducing pain, depression, fatigue, sleep disturbance and tender points and improving general health/function were 0.667 (95% CI 0.446, 0.889), 0.322 (95% CI 0.140, 0.504), 0.511 (95% CI 0.247, 0.774), 0.682 (95% CI 0.350, 1.014), 0.867 (95% CI 0.310, 1.425) and 0.473 (95% CI 0.285, 0.661), respectively. rTMS stimulation yielded a greater effect size compared with that of TDCS (effect size 0.698 and 0.568, respectively; P < 0.0001). The primary motor cortex (M1) stimulation yielded a subtle greater effect size in pain reduction compared with that of the dorsolateral prefrontal cortex (effect size 0.709 and 0.693, respectively; P < 0.0001). No linear relationships were found between the effect sizes and treatment regimens and dose. Most of reported adverse effects were minor. Conclusions: Both rTMS and TDCS may be feasible and safe modalities for treating FM. The general effects of rTMS and TDCS are compatible in FM patients. M1 stimulation may be better in pain reduction and the dorsolateral prefrontal cortex may be better in depression improvement.
... Recently several studies showed that rTMS over left DLPFC induced analgesic effects in both acute and chronic pain conditions [23][24][25]. Some studies have found beneficial effects of prefrontal rTMS for fibromyalgia [26], neuropathic pain [27] and other medically unexplained symptoms of pain [28,29]. However, as far as we know, there are no reports about the effect of rTMS for BMS. ...