Decreasing procedural pain over time of left prefrontal rTMS for depression: initial results from the open-label phase of a multi-site trial (OPT-TMS).
Decreasing procedural pain over time of left prefrontal rTMS for depression: initial results from the open-label phase of a multi-site trial (OPT-TMS).
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DOI：
10.1016/j.brs.2008.09.001
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发表时间：
2009-04
影响因子：
7.7
通讯作者：
George, Mark S.
中科院分区：
文献类型：
--
作者：
Anderson, Berry S.;Kavanagh, Katie;Borckardt, Jeffrey J.;Nahas, Ziad H.;Kose, Samet;Lisanby, Sarah H.;McDonald, William M.;Avery, David;Sackeim, Harold A.;George, Mark S.
人们对持续数周的每日左前额叶重复经颅磁刺激（rTMS）是否可能成为临床上有用的抗抑郁治疗非常感兴趣。虽然rTMS似乎在很大程度上是安全的，但许多患者报告说，这种程序有点痛苦，这可能会限制其最终的吸引力和实用性。我们分析了rTMS作为抑郁症治疗的多中心随机试验的开放标签阶段的中期结果，以调查左前额rTMS的程序性疼痛是否随时间变化。在假对照双盲rTMS治疗至少三周期间没有反应的单相抑郁患者，然后再接受三周（15次）的开放标签rTMS治疗。回顾性疼痛评级和状态情绪因素，从20名受试者进行了评估，使用视觉模拟量表（VAS）记录在计算机上之前和之后的每一个治疗（289届）。在15个疗程中，rTMS疼痛的主观报告较基线下降了48%。这种下降虽然在最初几天最大，但在治疗的3周内持续稳定（平均每次2.11分）。分析发现，rTMS会话（p<0.0001）对rTMS程序性疼痛的显著影响超过了主观情绪状态的变化。左前额叶rTMS的程序性疼痛随着时间的推移而减少，显然独立于其他情绪变化。由于rTMS头皮疼痛可能会随着时间的推移而下降，医生和患者可能会决定继续治疗，尽管最初的不适。一旦试验设盲期的数据可用，就可以更好地检验这些观察性数据。
There is much interest in whether daily left prefrontal repetitive transcranial magnetic stimulation (rTMS) over several weeks may become a clinically useful antidepressant treatment. Although rTMS appears largely safe, many patients report that this procedure is somewhat painful, which may restrict its ultimate appeal and utility. We analyzed interim results from the open-label phase of a multi-site randomized trial of rTMS as a treatment for depression to investigate whether the procedural pain of left prefrontal rTMS changes over time. Patients with unipolar depression who had failed to respond during at least three weeks of the sham-controlled double-masked rTMS were then offered three more weeks (15 sessions) of open-label rTMS. Retrospective pain ratings and state emotional factors from 20 subjects were assessed using visual analog scales (VAS) recorded on computers before and after each treatment (289 sessions). Over the 15 treatment sessions, subjective reports of the painfulness of rTMS decreased 48% from baseline. This reduction, although greatest in the first few days, continued steadily (average 2.11 points per session) over the 3 weeks of treatment. The analysis found a significant effect for rTMS-session (p<0.0001) on rTMS-procedural pain over and above changes in subjective emotional states. The procedural pain of left, prefrontal rTMS decreases over time, apparently independently of other emotional changes. Since rTMS scalp pain may decline over time, physicians and patients may decide to continue treatment despite initial discomfort. These observational data can be better tested once the data from the blinded phase of the trial becomes available.
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影响因子：
10.6
作者：
O'Reardon, John P.;Solvason, H. Brent;Sackeim, Harold A.
通讯作者：
Sackeim, Harold A.
影响因子：
1.7
作者：
Fox, P;Ingham, R;Jerabek, P
通讯作者：
Jerabek, P
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作者：
Avery, David H.;Holtzheimer, Paul E., III;Roy-Byrne, Peter
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Roy-Byrne, Peter
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作者：
Borckardt, Jeffrey J.;Smith, Arthur R.;George, Mark S.
通讯作者：
George, Mark S.
影响因子：
10.6
作者：
Herwig, U;Padberg, F;Schönfeldt-Lecuona, C
通讯作者：
Schönfeldt-Lecuona, C