Analgesic Effects of Repetitive Transcranial Magnetic Stimulation in Patients With Advanced Non-Small-Cell Lung Cancer: A Randomized, Sham-Controlled, Pilot Study

Abstract

ObjectiveCurrent pharmacological intervention for the cancer-related pain is still limited. The aim of this study was to explore whether repetitive transcranial magnetic stimulation (rTMS) could be an effective adjuvant therapy to reduce pain in patients with advanced non-small cell lung cancer (NSCLC).MethodsThis was a randomized, sham–controlled study. A total of 41 advanced NSCLC patients with uncontrolled pain (score≥4 on pain intensity assessed with an 11-point numeric rating scale) were randomized to receive active (10 Hz, 2000 stimuli) (n = 20) or sham rTMS (n = 20) for 3 weeks. Pain was the primary outcome and was assessed with the Numeric Rating Scale (NRS). Secondary outcomes were oral morphine equivalent (OME) daily dose, quality of life (WHO Quality of Life-BREF), and psychological distress (the Hospital Depression and Anxiety Scale). All outcomes were measured at baseline, 3 days, 1 week, 2 weeks, and 3 weeks.ResultsThe pain intensity in both groups decreased gradually from day 3 and decreased to the lowest at the week 3, with a decrease rate of 41.09% in the rTMS group and 23.23% in the sham group. The NRS score of the rTMS group was significantly lower than that of the sham group on the week 2 (p < 0.001, Cohen’s d =1.135) and week 3 (p=0.017, Cohen’s d = -0.822). The OME daily dose, physiology and psychology domains of WHOQOL-BREF scores, as well as the HAM-A and HAM-D scores all were significantly improved at week 3 in rTMS group.ConclusionAdvanced NSCL patients with cancer pain treated with rTMS showed better greater pain relief, lower dosage of opioid, and better mood states and quality of life. rTMS is expected to be a new effective adjuvant therapy for cancer pain in advanced NSCLC patients.

Intermittent theta-burst stimulation with physical exercise improves poststroke motor function: A systemic review and meta-analysis

“…Due to the loss of motor function after stroke, this excitatory stimulation has important implications for relearning during motor rehabilitation ( 13 ). In recent years, rTMS has been widely used to treat neuropsychiatric disorders such as depression, epilepsy, pain, and Parkinson's disease ( 14 – 17 ). However, despite the therapeutic potential, many participants reported adverse effects of rTMS, including headache, muscle twitching, and residual hypersensitivity ( 18 , 19 ).…”

Noninvasive Brain Stimulation for Cancer Pain Management in Nonbrain Malignancy: A Meta-Analysis

“…All studies were double-blind, parallel, sham-controlled RCTs with no baseline demographic diferences. Te included studies enrolled a total of 269 patients with pain secondary to malignancy including hepatocellular carcinoma (HCC) [33], breast cancer [35], nonsmall cell lung cancer (NSCLC) [36], or mixed-origin cancers [34]. Most of the studies reported chronic (at least 2 months) and uncontrolled pain secondary to the cancer itself or to cancer-related treatments, including surgery, chemotherapy, or radiotherapy [33,35,36].…”

“…Te baseline pain score was rated with the BPI at 1.24 to 1.45 and reevaluated twice during CES treatment of 1 hour stimulation per day for 2 weeks. In Tang et al's study, 39 patients with NSCLC had intractable pain even with the use of morphine or oxycodone [36]. Te patients received rTMS for 3 weeks targeting the left dorsolateral prefrontal cortex (DLPFC) with 1500 pulses of 10 Hz stimulation for 3 weeks.…”

“…Te initial pain score was evaluated by NPRS at 6.4 to 6.5 and reevaluated at the 3rd, 5th, 10 th , and 15th sessions. Sham stimulation included turning of the device without the participants' awareness [33], angling the setup away from the targeted brain location [34,36] or using sham devices [35].…”

“…All of the included studies had low risks of bias despite concerns about randomization concealment and missing outcomes from participants who withdrew from the study. Notably, patients predominantly withdrew for diseaserelated reasons [33,34,36], and patient adherence was high ranging from 83.3% to 100% [33,35]. Te details of the risks of bias assessment are listed in Supplementary Figure S2.…”