| Objective(s):Postherpetic neuralgia(PHN)is a kind of typical neuropathic pain that brings great pain to patients and often comorbid depression,which aggravates the physiological,psychological,and economic burden of patients.In recent years,as a non-invasive central nervous system neuromodulation technique,repetitive transcranial magnetic stimulation(rTMS)has attracted much attention because of its effectiveness in the treatment of mental and neurological diseases and chronic pain.At present,researchers mostly focus on its analgesic effect of rTMS in PHN,rather than whether it affects patients with PHN comorbid depression.In this study,a prospective,single-center,randomized controlled clinical study was conducted to evaluate the short-term efficacy and safety of rTMS in the treatment of PHN comorbid depression.Methods:Patients with PHN comorbid depression were enrolled and divided into two groups randomly.One group was treated with rTMS combined with pregabalin and intradermal nerve block,while the control group was treated with pregabalin and intradermal nerve block only.The main outcome measures were the changes of the Pain Self-Efficacy Questionnaire(PSEQ),to evaluate the degree of self-efficacy and confidence of patients in the context of pain,which is a comprehensive indicator that can reflect the impact of pain and depression on patients.The secondary outcomes included the Numerical Rating Scale(NRS)and Hospital Anxiety and Depression scale(HADS).The treatment phase lasted for 10 days,followed by a 1-month follow-up,and the above indicators were evaluated at the day of admission(T1),the day discharge(T2)and 1 month after discharge(T3).Results:A total of 34 patients were enrolled from May 2020 to January 2021,and a total of 31 patients completed the study.Including 15 patients in the control group and 16 patients in the rTMS group.There was no significant difference in the number,age,sex composition,and lesion location(side)distribution between the two groups(P>0.05).(1)Improvement of self-efficacy:the PSEQ scores of the two groups at T2 and T3 were significantly higher than those at T3,and the difference was statistically significant.There was no significant difference in PSEQ score between the rTMS group and Control group at T2(P>0.05),but PSEQ score at T3 was significantly higher than that in the Control group(P<0.0038).(2)Pain relief:the NRS scores of patients in the two groups at T2 and T3 were significantly lower than those at T1(P>0.05).Compared with the Control group,the NRS scores of patients in the rTMS group were lower at T1(5(4,5)vs.3(2,3),P=0.0046)and T3(4(4)vs.2(1.25)vs.2(1.25),0.0355),and the difference was statistically significant.Besides the NRS score of the rTMS group at T3 was still lower than that at T2,and the difference was statistically significant(P<0.0415),while there was no significant difference in NRS score between the Control group at T3 vs.at discharge(P>0.9999).(3)Improvement of depression:there was no significant difference in HADS depression score between the rTMS group(9.44±1.93 vs.11.56±2.90)and Control group(10.93±2.46vs.12.47±2.67)at T2 vs.T1(P>0.9999).Compared with the HADS depression score at T2,the rTMS group(11.56±2.90 vs.5.69±1.08,P<0.0001)and the Control group(12.47±2.67 vs.8.80±2.04,P<0.0312)were significant decreases at T3,the difference is statistically significant.Meanwhile,at T3,the score of the rTMS group was significantly lower than that of the Control group,and the difference was statistically significant(P<0.0487).Conclusion(s):rTMS can safely and effectively reduce the pain level,improve depression and self-efficacy of patients with PHN comorbid depression during 1-month follow-up.The effect of combination therapy is better than that of oral pregabalin+intradermal nerve block.And rTMS can produce a more lasting therapeutic effect. |
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