Indian Journal of Palliative Care
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Table of Contents 
LETTER TO EDITOR
Year : 2017  |  Volume : 23  |  Issue : 1  |  Page : 109-110

Repetitive transcranial magnetic stimulation as a promising potential therapeutic modality for the management of cancer-related pain: An Issue that merits further research


1 Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari; Department of Medical-Surgical Nursing, Student Research Committee, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
2 Department of Medical-Surgical Nursing, Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, Iran
3 Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
4 Department of Medical Surgical Nursing, School of Nursing and Midwifery, shahr University of Medical Sciences, shahr, Iran

Date of Web Publication10-Jan-2017

Correspondence Address:
Hassan Sharifi
Department of Medical Surgical Nursing, School of Nursing and Midwifery, Iranshahr University of Medical Sciences, Iranshahr
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1075.197950

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How to cite this article:
Emami Zeydi A, Esmaeili R, Hasanzadeh Kiabi F, Sharifi H. Repetitive transcranial magnetic stimulation as a promising potential therapeutic modality for the management of cancer-related pain: An Issue that merits further research. Indian J Palliat Care 2017;23:109-10

How to cite this URL:
Emami Zeydi A, Esmaeili R, Hasanzadeh Kiabi F, Sharifi H. Repetitive transcranial magnetic stimulation as a promising potential therapeutic modality for the management of cancer-related pain: An Issue that merits further research. Indian J Palliat Care [serial online] 2017 [cited 2017 Oct 18];23:109-10. Available from: http://www.jpalliativecare.com/text.asp?2017/23/1/109/197950


Sir,

Worldwide, cancer is a leading burden of disease.[1] During the process of cancer treatment, a wide range of physical and psychological sequels can occur. Cancer-related pain is one of the most frequent, critical, and fearsome symptoms in these patients.[2],[3] Globally, it is established that the majority of cancer patients experience moderate to severe pain during any phase of disease continuum, which can be caused directly by the disease or its treatment. Considering that cancer-related pain is often multidimensional, it can negatively affect many aspects of a patient's life and may have catastrophic consequences.[2],[4] Despite considerable advances in the pharmacologic and nonpharmacologic treatments for cancer-related pain, its management is an ongoing challenge for healthcare providers and has only limited success.[5] Although the exact mechanism of cancer-related pain has not yet been fully elucidated, neuroplasticity has been proposed as a relatively new plausible mechanism.[6],[7] There is growing evidence that many pain conditions, especially chronic pain, are associated with excitability and/or reorganization of the brain's motor cortex.[7] It has been suggested that these cortical structure and function alterations may be related to the occurrence of cancer-related pain. Therefore, it is believed that using modalities that direct the changes of motor cortex in these patients may reverse these changes and improve their clinical outcomes.[8]

As an alternative and noninvasive technique, transcranial magnetic stimulation (TMS) can safely stimulate the cortical neurons for attenuation of pain. It has been shown that repeated delivery of TMS pulses (rTMS) could enhance neuroplasticity for long-term therapeutic advantages; however, its therapeutic efficacy in chronic pain conditions is still controversial.[7],[9] There are currently very few studies to evaluate the efficacy of rTMS in patients with cancer. To date, only one case study has been published recently by Nizard et al., who evaluate and confirm the efficacy of rTMS therapy in treating severe cancer pain in two cases with refractory to conventional treatment. In this study, receiving 20-min sessions of rTMS applied to the right motor cortex, for 5 consecutive days, was associated with marked improvement in the patients' pain, anxiety, and mood. Furthermore, no significant adverse effect was reported.[10] To the best of our knowledge, there is no other published study in this regard.

Despite a dearth of research available, it seems that rTMS is a relatively safe, innovative, and effective alternative treatment for cancer-related pain. However, further well-designed clinical trials to determine its potential safety and efficacy in cancer patients, as well as its optimal delivered pulses/session and better choice of target for the application of rTMS are warranted.

 
  References Top

1.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin 2015;65:5-29.  Back to cited text no. 1
    
2.
Paice JA, Ferrell B. The management of cancer pain. CA Cancer J Clin 2011;61:157-82.  Back to cited text no. 2
    
3.
Shinde S, Gordon P, Sharma P, Gross J, Davis MP. Use of non-opioid analgesics as adjuvants to opioid analgesia for cancer pain management in an inpatient palliative unit: Does this improve pain control and reduce opioid requirements? Support Care Cancer 2015;23:695-703.  Back to cited text no. 3
    
4.
van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J. Prevalence of pain in patients with cancer: A systematic review of the past 40 years. Ann Oncol 2007;18:1437-49.  Back to cited text no. 4
    
5.
van den Beuken-van Everdingen MH, Hochstenbach LM, Joosten EA, Tjan-Heijnen VC, Janssen DJ. Update on prevalence of pain in patients with cancer: Systematic review and meta-analysis. J Pain Symptom Manage 2016;51:1070-90.e9.  Back to cited text no. 5
    
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Falk S, Bannister K, Dickenson AH. Cancer pain physiology. Br J Pain 2014;8:154-62.  Back to cited text no. 6
    
7.
Puretic MB, Demarin V. Neuroplasticity mechanisms in the pathophysiology of chronic pain. Acta Clin Croat 2012;51:425-9.  Back to cited text no. 7
    
8.
Prinsloo S, Gabel S, Lyle R, Cohen L. Neuromodulation of cancer pain. Integr Cancer Ther 2014;13:30-7.  Back to cited text no. 8
    
9.
O'Connell NE, Wand BM, Marston L, Spencer S, Desouza LH. Non-invasive brain stimulation techniques for chronic pain. Cochrane Database Syst Rev 2010;9:CD008208. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20824873. [Last accessed on 2016 Dec 20].  Back to cited text no. 9
    
10.
Nizard J, Levesque A, Denis N, de Chauvigny E, Lepeintre A, Raoul S, et al. Interest of repetitive transcranial magnetic stimulation of the motor cortex in the management of refractory cancer pain in palliative care: Two case reports. Palliat Med 2015;29:564-8.  Back to cited text no. 10
    




 

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