Laboratory studies have shown that prolonged continuous theta burst stimulation (pcTBS) provides better pain relief than 10 Hz repetitive transcranial magnetic stimulation (rTMS), with a shorter stimulation time, making it more practical for clinical use. Chemotherapy-induced peripheral neuropathy often causes neuropathic pain in cancer patients. The aims of this study are: 1. To compare the effects of pcTBS and 20 Hz rTMS on chemotherapy-induced peripheral neuropathy; 2. To compare the effects of pcTBS applied to the primary motor cortex versus the dorsolateral prefrontal cortex on neuropathic pain as well as depression and anxiety.
\*\*Phase 1:\*\* Investigators will recruit 20 breast cancer patients who have chemotherapy-induced peripheral neuropathy. They will be randomly divided into two groups. * Group 1 will first receive pcTBS. After an 8-week break, they will then receive 20 Hz rTMS. * Group 2 will receive the treatments in the opposite order. Each treatment lasts for 5 consecutive days. Before and after each treatment, patients will be assessed using: * A pain visual analog scale (to measure pain levels) * A Neuropathic Pain Symptom Inventory (The scale ranges from zero to 10, with zero indicating no pain at all and 10 indicating the worst imaginable pain) • \* A Depression Anxiety Stress Scale 21 (The scale ranges from 0-63, with a higher scores mean a worse outcome) o \* Clinical pressure pain threshold tests (Higher PPT values indicate a higher tolerance to pressure pain (less sensitivity). * Nerve conduction studies \*\*Phase 2:\*\* Another 20 breast cancer patients with chemotherapy-induced peripheral neuropathy will be recruited and randomly divided into two groups. * Group 1 will first receive pcTBS on the primary motor cortex. After an 8-week break, they will receive the same stimulation on the left dorsolateral prefrontal cortex. * Group 2 will receive the treatments in the opposite order.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
40
prolonged continuous theta burst stimulation
20 Hz repetitive transcranial magnetic stimulation
Taipei Tzu Chi Hospital
New Taipei City, Taiwan
visual analogue pain scale (VAS pain scale)
visual analogue pain scale (VAS) range from 0-100, with a higher score inducating more pain
Time frame: baseline, pre-intervention and immediately after completion the intervention and at 4 weeks follow-up
Depression Anxiety Stress Scale 21
Depression Anxiety Stress Scale 21 scale ranges from 0-63, with a higher scores mean a worse outcome.
Time frame: baseline and after completion the intervention and at 4 weeks follow-up
pressure pain threshold test
o Higher pressure pain threshold values indicate a higher tolerance to pressure pain (less sensitivity).
Time frame: baseline and after completion the intervention and at 4 weeks follow-up
Neuropathic Pain Symptom Inventory
Neuropathic Pain Symptom Inventory ranges from zero to 10, with zero indicating no pain at all and 10 indicating the worst imaginable pain.
Time frame: baseline and after completion the intervention and at 4 weeks follow-up
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