Accelerated rTMS for existential distress in palliative care: A report of two cases

Watt, Christine L.; Lapenskie, Julie; Kabir, Monisha; Lalumiere, Genevieve; Dionne, Michel; Rice, Jill; Noël, Chelsea; Downar, Jonathan; Downar, James

doi:10.1016/j.brs.2021.12.006

Cited by 9 publications

(4 citation statements)

References 10 publications

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“…Anxiety may, however, contribute to the distress that can be encountered in a palliative care setting. A recent publication suggests that tDCS may have an effect on this state of distress [64], which highlights the interest of an own assessment of anxiety.…”

Section: Clinical Parametersmentioning

confidence: 99%

Bicentre, randomized, parallel-arm, sham-controlled trial of transcranial direct-current stimulation (tDCS) in the treatment of palliative care patients with refractory cancer pain

Nǵuyen

Gaillard

Suarez³

et al. 2023

BMC Palliat Care

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Background Pain is a common symptom in palliative care cancer patients and is often insufficiently relieved. In recent years, transcranial direct-current stimulation (tDCS) of the motor cortex has been shown to be effective to treat chronic pain, essentially neuropathic pain. We propose to test the efficacy of tDCS in patients experiencing cancer pain in the palliative care setting. Method/design This article describes the protocol of a bicentre, randomized, parallel-arm, sham-controlled clinical trial evaluating tDCS in the treatment of palliative care patients with refractory cancer pain. Seventy patients between the ages of 18 and 80 years experiencing refractory pain with a pain score of 4/10 on a numerical rating scale (NRS) ranging from 0 to 10 will be enrolled in this trial. The main exclusion criteria are patients unable to fill in the various rating scales and life expectancy less than 3 weeks. Treatment consists of 5 consecutive tDCS sessions targeting the motor cortex (one daily session for 5 days) on the contralateral side to the pain. After randomization (1:1 ratio), 35 patients will receive active stimulation and 35 patients will receive sham stimulation. The primary endpoint is the NRS score and the primary objective is a significant improvement of this score between the baseline score recorded between D-3 and D-1 and the score recorded 4 days after stopping treatment (D8). The secondary objectives are to evaluate whether this improvement is maintained 16 days after stopping treatment (D21) and whether the following scores are improved on D14 and D21: Brief Pain Inventory, Edmonton Symptom Assessment System, Hospital Anxiety and Depression scale, State-Trait Anxiety Inventory and Medication Quantification Scale. Discussion Positive results of this trial would indicate that tDCS can improve pain and quality of life of cancer patients in the palliative care setting. Reduction of analgesic consumption and improvement of activities of daily living should allow many patients to return home with a decreased workload for caregivers.

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Section: Clinical Parametersmentioning

confidence: 99%

Bicentre, randomized, parallel-arm, sham-controlled trial of transcranial direct-current stimulation (tDCS) in the treatment of palliative care patients with refractory cancer pain

Nǵuyen

Gaillard

Suarez³

et al. 2023

BMC Palliat Care

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“…Similar to electric convulsive therapy, these therapies involve activating or inhibiting the brain with electricity and include vagus nerve stimulation, repetitive transcranial magnetic stimulation (rTMS), magnetic seizure therapy, and deep brain stimulation. Only one study to date reports using brain stimulation therapy to specifically treat ES in a palliative care setting using rTMS, and it involved a 5-day course of eight sessions per day delivered at 45-min intervals with 600 pulses of intermittent theta-burst stimulation per 3-min session, at 80% of resting motor threshold, targeting the left dorsolateral prefrontal cortex 26▪▪. See Table 3 to review case reports on accelerated rTMS’s effectiveness in managing dying persons’ ES.…”

Section: Review Of Current End Of Life Existential Suffering Therapeu...mentioning

confidence: 99%

Current practices in managing end-of-life existential suffering

Risio

Thompson

2023

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of review Within the context of palliative care, existential suffering (ES) can be an exclusive source of suffering or intertwined with physical pain and/or psychological and spiritual suffering. With newly emerging modalities for addressing this phenomenon and its increasing salience given that many patients cite ES as a significant contributing factor to requests for hastened death, a review of recent interventions for addressing ES at the end of life is timely. Recent findings This review of newer approaches to dealing with ES in the palliative context suggests some promising new modalities and pharmacological interventions, such as brain stimulation and the use of psychedelics. The use of other pharmacological interventions, such as palliative sedation and lethal injections, solely for the alleviation of existential distress remains ethically controversial and difficult to disentangle from other forms of suffering, not least because a clear clinical definition of ES has yet to emerge in the literature. Summary The evaluation of end-of-life (EOL) ES mitigating tools should also consider how broader contexts, such as institutional arrangements and barriers, and cultural factors may influence the optimal management of dying persons’ ES in the palliative care setting.

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“…La détresse existentielle est également difficile à traiter : une méta-analyse des interventions psychothérapeutiques visant à l’atténuer a révélé qu’aucun des principaux paramètres n’était amélioré par les interventions, et que, si certains des paramètres secondaires présentaient des améliorations modérées, ces améliorations avaient toutes disparu au suivi à court terme (3 mois) 13 . Peu de données existent sur les effets potentiels de thérapies innovantes et évolutives telles que le recours à des substances psychédéliques, la stimulation magnétique transcrânienne répétitive 14 et autres sur la détresse existentielle ou le désir d’AMM des personnes atteintes d’une maladie en phase terminale.…”

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Downar,

MacDonald,

Buchman

2024

CMAJ

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Accelerated rTMS for existential distress in palliative care: A report of two cases

Cited by 9 publications

References 10 publications

Bicentre, randomized, parallel-arm, sham-controlled trial of transcranial direct-current stimulation (tDCS) in the treatment of palliative care patients with refractory cancer pain

Bicentre, randomized, parallel-arm, sham-controlled trial of transcranial direct-current stimulation (tDCS) in the treatment of palliative care patients with refractory cancer pain

Current practices in managing end-of-life existential suffering

Qu’est-ce qui motive les demandes d’AMM?

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