Page 27 - Delaware Medical Journal - March 2016
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CASE STUDY
A study in healthy volunteers showed that rapidly stimulating the motor cortex via dTMS can raise the pain threshold of the corresponding body part.4
Case Study 2
A 60-year old woman with severe chronic low back pain, two failed low back surgeries, chronic MDD, and Post Traumatic Stress Disorder (PTSD) presented to us for management.
She needed a cane for ambulation. Her antidepressant was Cymbalta 60 mg/q daily and her pain medications were Fentanyl transdermal patch at 50microgram/hr patches and hydrocodone 10/325 three times daily. Prior to dTMS therapy the patient had an average VAS of 8/10. She underwent 26 dTMS sessions over
a period of seven weeks, including three weeks of taper. While undergoing dTMS therapy the patient self-reported that she was able to forego pain medications for six to seven days at a time and had vastly increased mobility (e.g., no longer needed her cane, was able to go dancing, and walked along the ocean on the beach
and her BDI to 11; an improvement of 20 points since beginning dTMS therapy (Figure 2). The patient also reported a decrease Four months post dTMS treatment her VAS decreased to 3/10. To date she has reduced her pain medications by 70 percent
and at times experiences no pain at all. She remained treatment compliant and experienced a few mild headaches during the initial week of treatment.
DISCUSSION
These two cases illustrate the therapeutic potential of dTMS as add-on therapy to patients with chronic low back pain
and MDD that is coincident and refractory to conventional treatment regimens even under optimal conditions. The symptoms and for low back pain was impressive and sustained for the period of follow up we report here. The putative mechanisms through which dTMS mediates pain relief is unclear. However, one possibility is that relief of MDD allows for better gating of pain and overall better tolerance of pain. The apparent improvement in the quality of life of our second patient is also impressive. The patient in
FIGURE 1
Male, 63, Moderate Chronic Depression, Chronic Lower Back Pain
Timeframe during dTMS Therapy
FIGURE 2
Female, 60, Severe Chronic Depression, PTSD, Chronic/Severe Lower Back Pain
Timeframe during dTMS Therapy
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