Effects of repetitive transcranial magnetic stimulation on pain and emotion of patients with neuropathic pain

Objective To investigate the effect of high⁃frequency repetitive transcranial magnetic stimulation (rTMS) on pain and emotion in patients with neuropathic pain (NP) combined with anxiety and/or depression. Methods A total of 39 patients with NP combined with anxiety and/or depression from June 2019 to October 2021 were included and randomly divided into conventional treatment combined with sham stimulation group (control group, n=19) and conventional treatment⁃assisted high⁃frequency rTMS (rTMS group, n=20). The Numerical Rating Scale (NRS) was used to evaluate the pain state, Hamilton Anxiety Scale⁃14 (HAMA⁃14) was used to evaluate the anxiety state, and Hamilton Depression Scale⁃17 (HAMD⁃17) was used to evaluate depression state before treatment and at 3 days, 1 week, 2 weeks, 3 weeks and 4 weeks of treatment. Results The NRS score (F=23.573, P=0.000) and HAMD score (F=15.426, P=0.000) before and after treatment were significantly different between the 2 groups. The NRS score and HAMD score in rTMS group were lower than those in control group at 1, 2, 3 and 4 weeks of treatment (P≤0.01, for all). The differences in NRS score (F=317.751, P=0.000), HAMA score (F=81.510, P=0.000) and HAMD score (F=32.773, P=0.000) at different observation times were also statistically significant in the same treatment group. In rTMS group, NRS score and HAMD score at 1, 2, 3 and 4 weeks of treatment were lower than those before treatment and 3 days of treatment (P＜0.01, for all), and HAMA score at 1, 2 and 3 weeks of treatment were lower than those before treatment and 3 days of treatment (P=0.000, for all). HAMA score at 4 weeks of treatment was lower than that before treatment (P=0.007), at 1 week (P=0.014) and 2 weeks (P=0.001) of treatment. In control group, NRS score only at 4 weeks of treatment was lower than that before treatment (P=0.000), HAMA score at 1, 2 and 3 weeks of treatment was lower than those before treatment (P＜0.05, for all), and HAMA score at 1 week of treatment was lower than that at 3 days of treatment (P=0.002). Spearman correlation analysis showed that the degree of pain relief before and after treatment was positively correlated with the ease of anxiety (rs=0.442, P=0.048) and depression (rs=0.705, P=0.001). Conclusions High⁃frequency rTMS is a safe and effective treatment for NP with anxiety and/or depression. It can significantly ease anxiety and depression in patients while relieving pain