Medicare Benefits Schedule item numbers for transcranial magnetic stimulation (TMS): Questions arising.

OBJECTIVE: Four Medicare Benefits Schedule item numbers for Transcranial Magnetic Stimulation (TMS) treatment of unresponsive MDD were declared in Australia in 2021. They are accompanied by rules/conditions. The aim is to consider these rules/conditions in light of recent research and real-world experience. CONCLUSIONS: While evidence supports some listed rules/conditions, others lack clinical justification and deserve to be reconsidered. These include (a) ineligibility of patients who have previously received TMS, (b) a lifetime total limit of 50 treatments, (c) a second/final course being unavailable for 4 months following the completion of the first course, and (d) the second/final course being limited to 15 treatments.

Tinnitus and suicide: recent cases on the public record give cause for reconsideration.

Suicides among tinnitus sufferers are rare. Indeed, on examining the public record (newspapers and the Web), the authors identified only 4 cases in the past 10 years that had been examined by a coroner. Nevertheless, the deaths of Rick Tharp, Dietrich Hectors, William Morris, and Robert McIndoe prompt reconsideration of the association between tinnitus and suicide that appears to be weak. The article also draws attention to a subject that is receiving attention in the medical literature--namely, the role of "precipitants" (in this case, tinnitus) in completed suicide and the need to screen some cases of severe, disabling tinnitus for the presence or absence of coinciding psychopathology, which is very amenable to treatment.

Substance use in a sample of medical patients.

The purpose of the current study was to assess the rate of substance use in patients with medical diseases who were admitted to different wards at Shiraz hospitals affiliated to the Shiraz University of Medical Sciences. Data were gathered from 600 randomly selected patients by a structured interview that included DSM-IV criteria for substance dependency. The mean ages for men and women were 45.8 and 44.7 years, respectively. In this group, 76.7% of the men and 83.7% of the women were married. The majority (29%) of the patients were current nicotine users, and 7.2% were opium users; none used cocaine or LSD. The reported reasons for initial use of substance(s), in order of frequencies, were enjoyment, modeling and release of tension; for current users the reasons were habit, enjoyment and need. Substance use, especially cigarettes, was found to be common among patients. Cultural attitudes toward substance use were thought to affect the type and amount of use. These findings can be considered when planning preventive programs.

Changes to somatosensory detection and pain thresholds following high frequency repetitive TMS of the motor cortex in individuals suffering from chronic pain.

Research has shown that transcranial magnetic stimulation (TMS) results in a transient reduction in the experience of chronic pain. The present research aimed to investigate whether a single session of high frequency TMS is able to change the sensory thresholds of individuals suffering from chronic pain. Detection and pain thresholds for cold and heat sensations were measured before and after 20Hz repetitive TMS (rTMS) administered over the motor cortex. A significant decrease in temperature for cold detection and pain thresholds and a significant increase in temperature for heat pain thresholds were evident following a single session of rTMS. In contrast, no change in detection and pain thresholds was obtained following sham rTMS. The finding that rTMS can have a direct effect on sensory thresholds in individuals suffering from chronic pain has implications for the therapeutic use of rTMS in the relief of chronic pain.

Fibromialgia para o psiquiatra / Fibromyalgia for the psychiatrist

A fibromialgia (FM) e muito comum em clinicas de dor e e,com nao pouca frequencia, encontrada na pratica psiquiatrica. E uma condicao pouco entendida...

Estimulacao magnetica transcraniana na depressao / Transcranial magnetic stimulation in depression

A estimulacao magnetica transcraniana (TMS) e uma nova tecnologia que promete ser um tratamento para transtornos psiquiatricos. Ela foi aplicada de uma forma experimental em uma vasta gama de condicoes. A evidencia atual sugere um...