Perception and Impact of Transcranial Magnetic Stimulation in Patients With Chronic Neuropathic Pain: A Longitudinal Qualitative Study

IF 3.4 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain Pub Date : 2025-09-15 DOI:10.1002/ejp.70127

Julien Nizard, Marie Faure, Nadine Attal, Jean-Paul Nguyen, Pierre-Henri Garnier, Rolland Peyron, Didier Bouhassira, Pierre Nizet, Jean-Pascal Lefaucheur

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引用次数: 0

Abstract

Background

Repetitive transcranial magnetic stimulation (rTMS) is recommended as a third-line treatment for chronic neuropathic pain. Because of its non-invasive nature and limited side effects, it is considered a good therapeutic option. rTMS efficacy on chronic neuropathic pain has been demonstrated in numerous quantitative studies. However, there are no qualitative studies to support these quantitative data.

Methods

Included patients presented with peripheral neuropathic pain related to polyneuropathy (n = 6), radiculopathy (n = 3) and traumatic or surgical nerve injury (n = 3). The target of the rTMS was the primary motor cortex. We conducted a longitudinal qualitative study consisting of two separate semi-structured interviews for all 12 participants from four different French multidisciplinary pain centres, one before starting treatment and the other after 2 months of rTMS treatment. Two separate manual analyses by two researchers were carried out, as were software analysis and data triangulation.

Results

Our study revealed an overall positive impression about rTMS treatment, with improvements in pain and activities of daily living. However, most participants felt that information on this treatment was inadequate because of difficulties in understanding the treatment mechanism. These difficulties frequently led to misrepresentations about the treatment, which could result in secondary fears, particularly in relation to the fear of cognitive capacity loss.

Conclusions

The results suggest possible areas for improvement, both in clinical practice and in care organisation. Information provided to patients could be optimised, with a focus on more personalised care, considering preliminary representations and fears, so as to further encourage adherence to treatment. Furthermore, it is necessary to train healthcare staff in order to optimise the care pathway for patients suffering from intractable chronic pain and to limit the risks of delays in treatment.

Significance Statement

rTMS treatment showed overall positive effects on pain and quality of life. Many participants lacked clear understanding of the treatment mechanism, leading to fear and misinformation. Improvements are needed in patient education and healthcare staff training to support therapy compliance and optimise care.

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经颅磁刺激对慢性神经性疼痛患者的感知和影响：一项纵向定性研究

背景：重复性经颅磁刺激（rTMS）被推荐作为慢性神经性疼痛的三线治疗。由于其非侵入性和有限的副作用，它被认为是一个很好的治疗选择。rTMS对慢性神经性疼痛的疗效已经在大量的定量研究中得到证实。然而，尚无定性研究来支持这些定量数据。方法纳入伴有多神经病变（n = 6）、神经根病变（n = 3）和外伤性或手术性神经损伤（n = 3）的周围神经性疼痛患者。rTMS的目标是初级运动皮层。我们对来自四个不同的法国多学科疼痛中心的所有12名参与者进行了纵向定性研究，包括两次独立的半结构化访谈，一次是在开始治疗前，另一次是在rTMS治疗2个月后。两名研究人员分别进行了两次手工分析，以及软件分析和数据三角测量。结果我们的研究揭示了rTMS治疗的总体积极印象，疼痛和日常生活活动的改善。然而，大多数与会者认为，由于难以理解治疗机制，关于这种治疗的资料是不充分的。这些困难经常导致对治疗的错误陈述，这可能导致继发性恐惧，特别是与对认知能力丧失的恐惧有关。结论：结果提示可能的改进领域，无论是在临床实践和护理组织。可以优化向患者提供的信息，将重点放在更加个性化的护理上，考虑到初步的陈述和恐惧，从而进一步鼓励患者坚持治疗。此外，有必要培训医护人员，以便为患有难治性慢性疼痛的患者优化护理途径，并限制治疗延误的风险。rTMS治疗在疼痛和生活质量方面显示出总体积极的效果。许多参与者对治疗机制缺乏清晰的认识，导致恐惧和错误信息。需要改进患者教育和医护人员培训，以支持治疗依从性和优化护理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.