SOURCE: Pain Physician. 26(3):E223-E231, 2023 May.
AUTHORS: Leung A; Alhaqab S; Kunne A; Leung D; Krug P; Golshan S
ABSTRACT
BACKGROUND: Transcranial magnetic stimulation (TMS) and transcutaneous magnetic stimulation (tMS) offer a novel noninvasive treatment option for chronic pain. While the recent COVID-19 pandemic caused by the SARS-CoV-2 virus resulted in a temporary interruption of the treatments for patients, it provided an excellent opportunity to assess the long-term sustainability of the treatment, and the feasibility of resuming the treatments after a brief period of interruption as no such data are available in current literature.
METHODS: First, a list of patients whose pain/headache conditions have been stably controlled with either treatment for at least 6 months prior to the 3-month pandemic-related shutdown was generated. Those who returned for treatments after the shutdown were identified and their underlying pain diagnoses, pre- and posttreatment Mechanical Visual Analog Scale (M-VAS) pain scores, 3-item Pain, Enjoyment, and General Activity (PEG-3), and Patient Health Questionnaire-9 scores were assessed in 3 phases: Phase I (P1) consisted of a 6-month pre-COVID-19 period in which pain conditions were stably managed with either treatment modality; Phase II (P2) consisted of the first treatment visit period immediately after COVID-19 shutdown; and Phase III (P3) consisted of a 3-4 month post-COVID-19 shutdown period patients received up to 3 sessions of either treatment modality after the P2 treatment.
RESULTS: For pre- and posttreatment M-VAS pain scores, mixed-effect analyses for both treatment groups demonstrated significant (P < 0.01) time interactions across all phases. For pretreatment M-VAS pain scores, TMS (n = 27) between-phase analyses indicated a significant (F = 13.572, P = 0.002) increase from 37.7 +/- 27.6 at P1 to 49.6 +/- 25.9 at P2, which then decreased significantly (F = 12.752, P = 0.001) back to an average score of 37.1 +/- 24.7 at P3. Similarly, tMS (n = 25) between-phase analyses indicated the mean pretreatment pain score (mean +/- standard deviation [SD]) increased significantly (F = 13.383, P = 0.003) from 34.9 +/- 25.1 at P1 to 56.3 +/- 27.0 at P2, which then decreased significantly (F = 5.464, P = 0.027) back to an average score of 41.9 +/- 26.4 at P3.
For posttreatment pain scores, the TMS group between-phase analysis indicated the mean posttreatment pain score (mean +/- SD) increased significantly (F = 14.206, P = 0.002) from 25.6 +/- 22.9 at P1 to 36.2 +/- 23.4 at P2, which then significantly decreased (F = 16.063, P < 0.001) back to an average score of 23.2 +/- 21.3 at P3. The tMS group between-phase analysis indicates a significant (F = 8.324, P = 0.012) interaction between P1 and P2 only with the mean posttreatment pain score (mean +/- SD) increased from 24.9 +/- 25.7 at P1 to 36.9 +/- 26.7 at P2. The combined PEG-3 score between-phase analyses demonstrated similar significant (P < 0.001) changes across the phases in both treatment groups.
CONCLUSIONS: Both TMS and tMS treatment interruptions resulted in an increase of pain/headache severity and interference of quality of life and functions. However, the pain/headache symptoms, patients’ quality of life, or function can quickly be improved once the maintenance treatments were restarted.
LINK TO FULL ARTICLE: https://pubmed.ncbi.nlm.nih.gov/37192245/
