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CASE STUDY
quality of life although not as dramatic as in the second case.
case studies illustrate the potential for dTMS therapy in chronic pain. More research is also needed to establish if stimulating additional brain areas transcranially will help treat chronic pain more effectively; or perhaps if various pain conditions should be volunteers showed that rapidly stimulating the motor cortex
via dTMS can raise the pain threshold of the corresponding body part.4
Therefore, it is possible that the dTMS effects on chronic pain may be mediated via this mechanism while its effects on MDD is mediated via the dorsolateral prefrontal cortex mediated pathways.
dTMS therapy depression protocol only targets and treats the DLPFC at a maximum depth of 5 cms.; however, due to the extensive interconnectivity of brain regions that are stimulated, the effects of dTMS may have a much broader therapeutic reach than initially understood. Further, additional studies are required to see how long the analgesic effects of dTMS can last as clinical studies have shown that dTMS effects on maintaining depression remission in MDD have been six months or longer.5
CONCLUSION
Clinical depression and chronic low back pain are two debilitating co-morbidities that appear to have a partially symbiotic relationship. Managing patients with chronic pain
REFERENCES
1. Gaynes BN, Lloyd SW, Lux L, et al. Repetitive transcranial magnetic stimulation for treatment-resistant depression: a systematic review and meta-analysis. J Clin Psychiatry. 2014;75:477-489.
2. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2163-2196.
3. Balague F, Mannion AF, Pellise F, Cedraschi C. Non-specific low back pain. Lancet. 2012;379:482-491.
with physical, manual and massage therapies, acupuncture, injections, non opioid and opioids drugs and if necessary, surgery, can be ineffective over time and may lead to adverse effects. dTMS may serve as a potential add-on therapy that
is mediated via its network wide effects independent or complementary to the effects of the algorithmic approach to pain management. dTMS may also provide much easier access to therapy as there is no potential for abuse and it may have the potential to reduce narcotic and substance abuse in the long run in patients with co-existing morbidities of MDD and chronic low back pain.
CONTRIBUTING AUTHORS
■ ERIN YATES, BSc is a graduate of Columbia University with a degree in Neuroscience. She has treated TMS patients in California and Delaware, and currently is the TMS Program Director at Delaware TMS in Dover.
■ GANESH BALU, MD is board certified in Physical Medicine & Rehabilitation and Pain Medicine. He has offered comprehensive and integrative chronic pain management program in multiple Delaware locations for the past 16 years.
Their team is supported by Tarak Patel, DC and Zac Patterson, DC.
4. Maarrawi J, Peyron R, Mertens P, et al. Motor cortex stimulation for pain control induces changes in the endogenous opioid system. Neurology. 2007;69:827-834.
5.
Rapinesi C, Curto M, Kotzalidis G, et al. Antidepressant effectiveness of deep Transcranial Magnetic Stimulation (dTMS) in patients with Major Depressive Disorder (MDD) with or without Alcohol Use Disorders (AUDs): A 6-month, open label, follow-up study. Journal of Affective Disorders. 2015;174:57-63.
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Del Med J
| March 2016
| Vol. 88
| No. 3
