Past Issues

Objectives: Medically unexplained symptoms of pain (MUS-pain) are common
in patients with depression and can worsen clinical outcomes. High-frequency
repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral
prefrontal cortex (DLPFC) has been proven effective for managing treatment-resistant
depression and chronic pain, and might relieve chronic MUS-pain. But
whether left prefrontal rTMS has analgesic effects on MUS-pain remains unclear.
Methods: A randomized sham-controlled rTMS study (10-Hz, 1600 pulses/session,
10 sessions) was conducted for 2 weeks to determine whether rTMS is effective
in treating medication-resistant depressed patients with MUS-pain (n = 24).
Furthermore, in another left prefrontal 10-Hz rTMS study originally targeting at
antidepressant effects, we applied a 10-session rTMS therapy in patients with depression
and MUS-pain (n = 16) and those with depression alone (n = 10) and
followed them for another three months, in order to investigate the interaction between
painful and depressive symptoms. Results: In this study, we totally recruited
40 patients with MUS-pain and 10 patients without MUS-pain. We found that a
two-week navigated 10-Hz rTMS over the left DLPFC was signifi cantly more effective
in treating MUS-pain than sham rTMS (p < 0.05), and the analgesic effects
of the treatment was independent of its antidepressant effects. We also found a
higher rate of relapse for depression in patients whose MUS-pain responded poorly
to rTMS. Conclusion: Our report has identifi ed an rTMS analgesic effect for
MUS-pain in depressed patients. Our data strongly indicate that MUS-pain should
be aggressively identifi ed in patients with major depressive disorder because of its
detrimental effect on treatment outcome.