Changes in pain following bilateral intermittent theta-burst, transcranial magnetic stimulation for depression: A retrospective chart review

Pain management in patients with chronic pain and comorbid depression is challenging and understudied. There is interest in intermittent theta-burst stimulation (iTBS), a new modality of repetitive transcranial magnetic stimulation (rTMS). This retrospective review describes changes in pain, anxiety and depression throughout iTBS treatment at the dorsolateral prefrontal cortex (DLPFC). A retrospective chart review was conducted of patients who underwent their first acute series of iTBS treatments at the DLPFC for depression at a single institution between 2020 and 2023. Data on depression, anxiety, and pain were collected throughout iTBS treatment using the Beck Depression Inventory–II (BDI-II; higher scores indicate worse depression) and visual analogue scale (VAS; 0–100, higher scores indicate worse pain, anxiety, and depression). Nonparametric tests were used for all analyses. Of 104 patients, 52 reported moderate pain at baseline (50.0%). Median BDI-II scores decreased from 38.0 (interquartile range [IQR] = 29.0–44.0) to 24.0 (IQR = 9.0–36.0) from pre- to posttreatment (<i>P</i> &lt; 0.001). Of the 32 patients with both pre- and posttreatment pain scores, there was a significant decrease from 40.0 (IQR = 5.5–71.8) to 15.0 (IQR = 3.5–53.8; <i>P</i> = 0.037). In patients with at least moderate pain at baseline, pain scores decreased from 71.0 (IQR = 55.0–80.0) to 20.0 (IQR = 11.0–71.0; <i>P</i> = 0.004). Ten of 32 patients with available pre- and posttreatment scores reported ≥30% reduction in pain scores (31.2%). These preliminary results, suggesting decreases in pain following iTBS treatment, provide a rationale for future rigorous investigations to evaluate this intervention for depression and comorbid chronic pain.