The analgesic effect of therapeutic rTMS is not mediated or predicted by comorbid psychiatric or sleep disorders

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Lindholm , P , Lamusuo , S , Taiminen , T , Virtanen , A , Pertovaara , A , Forssell , H , Hagelberg , N & Jaaskelainen , S 2016 , ' The analgesic effect of therapeutic rTMS is not mediated or predicted by comorbid psychiatric or sleep disorders ' , Medicine (Baltimore) , vol. 95 , no. 44 , 5231 . https://doi.org/10.1097/MD.0000000000005231

Title: The analgesic effect of therapeutic rTMS is not mediated or predicted by comorbid psychiatric or sleep disorders
Author: Lindholm, Pauliina; Lamusuo, Salla; Taiminen, Tero; Virtanen, Arja; Pertovaara, Antti; Forssell, Heli; Hagelberg, Nora; Jaaskelainen, Satu
Contributor: University of Helsinki, Medicum
Date: 2016-11
Language: eng
Number of pages: 7
Belongs to series: Medicine (Baltimore)
ISSN: 0025-7974
URI: http://hdl.handle.net/10138/172531
Abstract: Background: Mechanisms underlying alleviation of neuropathic pain by repetitive transcranial magnetic stimulation (rTMS) of primary motor cortex (M1) and right secondary somatosensory cortex (S2) are only partly known. Patients with chronic neuropathic pain often have comorbidities like depression and sleep problems. Through functional connectivity, rTMS of M1 and S2 may activate dorsolateral prefrontal cortex, the target for treating depression with rTMS. Thus, the analgesic effect of rTMS could be mediated indirectly via improvement of psychiatric comorbidities or sleep. We examined whether rTMS has an independent analgesic effect or whether its clinical benefits depend on effects on mood or sleep. We also evaluated if comorbid psychiatric or sleep disorders predict the treatment outcome. Methods: Sixteen patients with chronic drug-resistant neuropathic orofacial pain participated in this randomized controlled crossover rTMS study. Patients' psychiatric history was evaluated by a specialist in psychiatry. Intensity and interference of pain, mood, and the quality of sleep and life were evaluated at baseline and after 2 active (primary somatosensory cortex [S1]/M1 and S2) and placebo rTMS treatments. A logistic regression analysis was done to investigate predictors of treatment outcome. Results: The analgesic effect of the right S2 stimulation was not associated with improvement of psychiatric conditions or sleep, whereas S1 /M1 stimulation improved sleep without significant analgesic effect (P=0.013-0.0/16 in sleep scores). Psychiatric and sleep disorders were more common in patients than in the general population (P=0.000-0.001 in sleep scores), but these comorbidities did not predict the rTMS treatment outcome. Conclusion: We conclude that rTMS to the right S2 does not exert its beneficial analgesic effects in chronic neuropathic orofacial pain via indirect improvement of comorbid psychiatric or sleep disorders.
Subject: neuropathic orofacial pain
psychiatric disorders
repetitive transcranial magnetic stimulation
secondary somatosensory cortex
sleep disorders
TRANSCRANIAL MAGNETIC STIMULATION
BURNING MOUTH SYNDROME
ATYPICAL FACIAL-PAIN
CHRONIC NEUROPATHIC PAIN
PRIMARY MOTOR CORTEX
FUNCTIONAL CONNECTIVITY
PREFRONTAL CORTEX
MEDICAL OUTCOMES
PSYCHOMETRIC PROPERTIES
HEALTHY-SUBJECTS
3121 Internal medicine
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