RESUMO
The purpose of this trial was to test whether right prefrontal cortex 1â¯Hz versus 10â¯Hz rTMS provides a significantly greater improvement in PTSD symptoms and/or function. Veterans 18 to 50 years of age suffering from PTSD were randomized to right prefrontal 1â¯Hz rTMS [2400 pulses/session] versus right prefrontal 10â¯Hz rTMS [2400 pulses/session]. The treatments were performed 5 days a week for 6 weeks with a 3-week taper using the NeuroStar system. There were one month and three months post treatment follow-up evaluations. Forty-four participants were enrolled with 17 being randomized to 1â¯Hz rTMS and 18 to 10â¯Hz rTMS. Both groups had significant improvement in PTSD and depression scores from baseline to the end of acute treatment. The 10â¯Hz group but not the 1â¯Hz group demonstrated significant improvement in function. Although both groups demonstrated significant improvement in PTSD and depression symptoms, a significant advantage for either the 1â¯Hz or 10â¯Hz frequency group on any of the scales acquired was not demonstrated. Further work is required with larger samples sizes to test whether low or high frequency is superior or if individual differences would indicate the more effective frequency.
Assuntos
Transtornos de Estresse Pós-Traumáticos/terapia , Estimulação Magnética Transcraniana/métodos , Veteranos/psicologia , Adolescente , Adulto , Depressão/psicologia , Depressão/terapia , Transtorno Depressivo/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Córtex Pré-Frontal/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Resultado do Tratamento , Adulto JovemRESUMO
The purpose of this paper is to review the rationale for concurrent, evidence-based treatment of chronic pain and posttraumatic stress disorder (PTSD). To meet this end, we review pertinent definitions and extant theories related to the two conditions and their correlations with each other. We then synthesize theoretical components into a proposal of a comprehensive conceptual framework for understanding the relationship and clinical complexity of overlapping chronic pain and PTSD. We conclude with an example of an integrated treatment model designed specifically to address a fundamental factor associated with pain and PTSD: avoidance.