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Abstract
Background and Aims Persistent pain may occur after modified radical mastectomy(MRM) in 20% and 50% of patients. This post-mastectomy pain syndrome (PMPS) is multifactorial, affects the quality of life(QoL) of patients and its treatment is often ineffective. Our aim was to determine whether adjuvant rTMS of motor cortex reduces pain and improves QoL in patients with PMPS.
Methods After ethics approval, 30 adult females with PMPS after MRM were randomised into two groups of 15 each to receive 15 sessions of rTMS and sham rTMS respectively. The pain of patients and QoL was assessed using VAS, short form McGillpain[SF-MPQ] questionnaire, somatosensory evoked responses and FACT-B respectively. rTMS was given in 20 trains of 60 pulses with an inter-train interval of 60 seconds. In sham group the coil was angled away from the head to produce subjective sensations of rTMS to ensure that the magnetic field did not penetrate the scalp. (figure 1) Each session lasted 20 minutes and 58 seconds.
Results The demography parameters, and pre-therapy pain scores were comparable. (table 1) rTMS resulted in a significant decrease in VAS score, SF-MPQ, CDT, WDT and CPT scores. The overall quality of life as assessed using FACT-B scores was also significantly better with rTMS. (figure 2)
Demographic data, pain scores and in two groups. Data as mean(SD). *pvalue for differences in the pain scores from baseline between the two groups using one-way ANOVA after checking normality with Shapiro-Wilk normality test. ** p value for the pre and post for the group using Wilcoxon matched-pairs signed rank test after checking normality with Shapiro-Wilk normality test. Values represented as Median interquartile range)
A: determination of RMT; B: real rTMS therapy and C: sham rTMS therapy
Conclusions Administration of 15 sessions of 10 Hz rTMS on motor cortex resulted in the improvement of pain status, quality of life and thermal sensitivity in patients with PMPS. No serious adverse effects were found indicating that rTMS is safe and can be given as an adjuvant therapy to PMPS patients.
Ethics approval