Abstract
Major depressive disorder (MDD) and chronic pain are highly comorbid, and pain symptoms are associated with a poorer response to antidepressant medication treatment. It is unclear whether comorbid pain also is associated with a poorer response to treatment with repetitive transcranial magnetic stimulation (rTMS). 162 MDD subjects received 30 sessions of 10 Hz rTMS treatment administered to the left dorsolateral prefrontal cortex (DLPFC) with depression and pain symptoms measured before and after treatment. For a subset of 96 patients, a resting-state electroencephalogram (EEG) was recorded at baseline. Clinical outcome was compared between subjects with and without comorbid pain, and the relationships among outcome, pain severity, individual peak alpha frequency (PAF), and PAF phase-coherence in the EEG were examined. 64.8% of all subjects reported pain, and both depressive and pain symptoms were significantly reduced after rTMS treatment, irrespective of age or gender. Patients with severe pain were 27% less likely to respond to MDD treatment than pain-free individuals. PAF was positively associated with pain severity. PAF phase-coherence in the somatosensory and default mode networks was significantly lower for MDD subjects with pain who failed to respond to MDD treatment. Pain symptoms improved after rTMS to left DLPFC in MDD irrespective of age or gender, although the presence of chronic pain symptoms reduced the likelihood of treatment response. Individual PAF and baseline phase-coherence in the sensorimotor and midline regions may represent predictors of rTMS treatment outcome in comorbid pain and MDD.
Highlights
Major depressive disorder (MDD) and chronic pain are highly comorbid, especially in female patients (Bair et al, 2004)
RTMS treatment significantly reduced depressive and pain symptoms (ANOVA, F = 3.8, p = 0.02), and posthoc t tests showed pain improvement by treatment 15 with further improvement seen at treatment 30 (T15, p15 = 0.0088, T30, p30 = 0.0067, Fig. 1c)
EEG analysis revealed that individual peak alpha frequency (PAF) was positively associated with chronic pain severity while baseline phase-coherence along the midline and sensorimotor regions was significantly lower among non-responders/non-remitters than in responders/remitters with comorbid pain
Summary
Major depressive disorder (MDD) and chronic pain are highly comorbid, especially in female patients (Bair et al, 2004). Several studies have suggested that affective disorders and chronic pain have an overlapping pathophysiology and may share similar circuit mechanisms (Bair et al, 2003; Taylor, Becker, Schweinhardt, & Cahill, 2016) While both depression and pain symptoms can be alleviated by antidepressant medications (Gracely, Ceko, & Bushnell, 2012; Maletic & Raison, 2009), this comorbidity has generally been associated with greater resistance to pharmacological treatment (Bair et al, 2004, 2003; Gerrits et al, 2012; Leuchter et al, 2010; Von Korff & Simon, 1996). Major depressive disorder (MDD) and chronic pain are highly comorbid, and pain symptoms are associated with a poorer response to antidepressant medication treatment.
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