Background

Repetitive transcranial magnetic stimulation (rTMS) is an efficacious and well-tolerated intervention for treatment-resistant depression (TRD). A novel rTMS protocol, intermittent theta burst stimulation (iTBS) has been recently implemented in clinical practice, and it is essential to characterize the factors associated to pain and the trajectory of pain of iTBS compared to standard rTMS protocols.

Objective

We aimed to characterize the side effect profile and the pain trajectories of High-Frequency Left (HFL) and iTBS in TRD patients in the THREE-D trial. We also investigated factors associated to pain and the relationship between pain and clinical outcomes.

Methods

414 patients were randomized to either HFL or iTBS. Severity of pain was measured after every treatment. General Estimating Equation was used to investigate factors associated with pain. Latent class linear mixed model was used to investigate latent classes of pain trajectories over the course of rTMS.

Results

Higher level of pain was associated with older age, higher stimulation intensity, higher anxiety, female, and non-response. The severity of pain significantly declined over the course of treatments with a steeper decrease early on in the course of the treatment in both protocols, and four latent pain trajectories were identified. The less favorable pain trajectories were associated with non-response and higher stimulation intensity.

Conclusions

HFL and iTBS were associated with similar factors and pain trajectories, although iTBS was more uncomfortable. Response to rTMS was associated with less pain and more favorable pain trajectories furthering the evince base of overlapping neurobiological underpinnings of mood and pain. We translated these results into patient-oriented information to aid in the decision-making process when considering rTMS.

中文翻译：

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以患者为导向的疼痛副作用分析：在 rTMS 期间改善患者体验的一个步骤？

背景

重复经颅磁刺激 (rTMS) 是治疗难治性抑郁症 (TRD) 的一种有效且耐受良好的干预措施。最近在临床实践中实施了一种新的 rTMS 协议，间歇性 theta 脉冲刺激 (iTBS)，与标准 rTMS 协议相比，表征与疼痛相关的因素和 iTBS 的疼痛轨迹至关重要。

客观的

我们旨在表征 THREE-D 试验中 TRD 患者中高频左 (HFL) 和 iTBS 的副作用特征和疼痛轨迹。我们还调查了与疼痛相关的因素以及疼痛与临床结果之间的关系。

方法

414 名患者被随机分配至 HFL 或 iTBS。每次治疗后测量疼痛的严重程度。一般估计方程用于研究与疼痛相关的因素。潜在类别线性混合模型用于研究 rTMS 过程中疼痛轨迹的潜在类别。

结果

较高的疼痛程度与年龄较大、刺激强度较高、焦虑程度较高、女性和无反应有关。在两种方案的治疗过程中，疼痛的严重程度在治疗过程中显着下降，并在治疗过程的早期急剧下降，并确定了四个潜在的疼痛轨迹。不太有利的疼痛轨迹与无反应和较高的刺激强度有关。

结论

HFL 和 iTBS 与相似的因素和疼痛轨迹相关，尽管 iTBS 更不舒服。对 rTMS 的反应与更少的疼痛和更有利的疼痛轨迹相关，进一步证实了情绪和疼痛的重叠神经生物学基础的证据基础。我们将这些结果转化为面向患者的信息，以在考虑 rTMS 时帮助决策过程。