Veterans Medical Research Foundation, San Diego, CA; Veteran Affairs San Diego Healthcare System, San Diego, CA; University of California, San Diego, School of Medicine, Department of Anesthesiology, La Jolla, CA.
Veteran Affairs San Diego Healthcare System, San Diego, CA.
Pain Physician. 2023 May;26(3):E223-E231.
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.
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.
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.
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.
经颅磁刺激（TMS）和经皮磁刺激（tMS）为慢性疼痛提供了一种新颖的非侵入性治疗选择。虽然最近由 SARS-CoV-2 病毒引起的 COVID-19 大流行导致患者的治疗暂时中断，但这为评估治疗的长期可持续性提供了极好的机会，并且在短暂中断后恢复治疗的可行性也提供了机会，因为目前的文献中没有此类数据。
首先，生成了一份患者名单，这些患者的疼痛/头痛状况在与 COVID-19 相关的 3 个月关闭之前至少通过治疗稳定控制了 6 个月。那些在关闭后回来接受治疗的人被识别出来，并评估了他们的潜在疼痛诊断、治疗前后机械视觉模拟量表（M-VAS）疼痛评分、3 项疼痛、享受和一般活动（PEG-3）和患者健康问卷-9 评分在 3 个阶段：第 I 阶段（P1）由 COVID-19 之前的 6 个月组成，在此期间，疼痛状况通过任何一种治疗方式稳定控制；第 II 阶段（P2）由 COVID-19 关闭后立即进行的首次治疗就诊期组成；第 III 阶段（P3）由 COVID-19 关闭后 3-4 个月组成，在此期间，患者在 P2 治疗后接受了多达 3 次任何一种治疗方式。
对于治疗前后的 M-VAS 疼痛评分，两组治疗的混合效应分析均显示所有阶段均存在显著的（P <0.01）时间交互作用。对于治疗前的 M-VAS 疼痛评分，TMS（n=27）的各阶段分析表明，从 P1 的 37.7±27.6 到 P2 的 49.6±25.9，有显著的（F=13.572，P=0.002）增加，然后显著（F=12.752，P=0.001）降低至 P3 的平均分数 37.1±24.7。同样，tMS（n=25）的各阶段分析表明，平均治疗前疼痛评分（均值±标准差[SD]）从 P1 的 34.9±25.1 显著增加（F=13.383，P=0.003）至 P2 的 56.3±27.0，然后显著降低（F=5.464，P=0.027）至 P3 的平均分数 41.9±26.4。对于治疗后的疼痛评分，TMS 组的各阶段分析表明，治疗后疼痛评分的均值（均值±SD）从 P1 的 25.6±22.9 显著增加（F=14.206，P=0.002）至 P2 的 36.2±23.4，然后显著降低（F=16.063，P<0.001）至 P3 的平均分数 23.2±21.3。tMS 组的各阶段分析表明，只有 P1 和 P2 之间存在显著的（F=8.324，P=0.012）交互作用，治疗后疼痛评分的均值（均值±SD）从 P1 的 24.9±25.7 增加到 P2 的 36.9±26.7。PEG-3 综合评分的各阶段分析表明，两组治疗均发生了显著的（P<0.001）变化。
TMS 和 tMS 治疗中断均导致疼痛/头痛严重程度增加，生活质量和功能受到干扰。然而，一旦开始维持治疗，疼痛/头痛症状、患者的生活质量或功能可以迅速得到改善。
