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DTMS Combined with a Pain-directed Psychotherapeutic Intervention in Fibromyalgia - A Randomized Double-blind Sham-controlled Study
- E. Tilbor, A. Hadar, V. Portnoy, O. Ganor, Y. Braw, H. Amital, J. Ablin, C. Dror, Y. Bloch, U. Nitzan
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S249
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Introduction
Fibromyalgia Syndrome (FMS) is a highly prevalent condition, causing chronic pain and severe reduction in quality of life and productivity, as well as social isolation (Birtane et al. Clinical Rheumatology 2007; 26(5), pp. 679–684; Arnold et al. Psychosomatics. England 2010; 51(6), pp. 489–497; Lacasse, Bourgault and Choinière. BMC Musculoskeletal Disorders 2016; 17(1), pp. 1–9). Despite significant morbidity and economic burden caused by FMS, current treatments are scarce (Busch et al. The Journal of rheumatology. Canada 2008; 35(6), pp. 1130–1144; Bernardy et al. Journal of Rheumatology 2010; 37(10), pp. 1991–2005; Jackson et al. American journal of hematology 2016; 91(5), pp. 476–80).
ObjectivesTo examine whether stimulation of the dorsal Anterior-Cingulate-Cortex and the medial Prefrontal-Cortex (ACC-mPFC) activity by deep Transcranial Magnetic Stimulation (dTMS) enhances a pain-directed psychotherapeutic intervention.
MethodsNineteen FMS patients were randomized to either 20 sessions of dTMS or sham stimulation, each followed by a pain-directed psychotherapeutic intervention. Using H7 HAC-coil or sham stimulation, we targeted the ACC-mPFC; specific brain areas that have a central role in pain processing (Fomberstein, Qadri and Ramani. Current Opinion in Anaesthesiology 2013; 26(5), pp. 588–593; Tendler, A. et al. Expert Review of Medical Devices 2016; 13(10), pp. 987–1000). Clinical response to treatment was evaluated using the McGill Pain Questionnaire (MPQ), Visual Analogue Fibromyalgia Impact Questionnaire (VAS-FIQ), Brief Pain Inventory questionnaire (BPI), and the Hamilton Depression Rating Scale (HDRS).
ResultsDTMS treatment was safe and well tolerated by FMS patients. A significant decrease in the sensory and affective pain dimensions was demonstrated specifically in the dTMS cohort, as measured by the MPQ using paired-sample t-tests with Bonferroni correction for multiple comparisons on three-time points (Significant group x time interaction [F(2, 34) = 3.79, p < .05, η2 = 0.183]. No significant changes were found in the cognitive functions, psychophysical measurements of pain, or depressive symptoms in both dTMS and sham groups and between groups.
ConclusionsOur findings suggest that a course of dTMS combined with a pain-directed psychotherapeutic intervention can alleviate pain symptoms in FMS patients. Beyond the clinical possibilities, future studies are needed to substantiate the innovative hypothesis that it is not the dTMS alone, but rather dTMS driven plasticity of pain-related networks, that enables the efficacy of pain-directed psychotherapeutic interventions.
Disclosure of InterestNone Declared
Clinical investigation of Xerophthalmia and Dystrophy in Infants and Young Children (Xerophthalmia et Dystrophia Alipogenetica)
- C. E. Bloch
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- Journal:
- Journal of Hygiene / Volume 19 / Issue 3 / January 1921
- Published online by Cambridge University Press:
- 15 May 2009, pp. 283-304
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1. There are fats which are indispensable for children because they contain specific bodies, essential for normal growth.
2. If these lipoid bodies, termed “fat soluble A bodies” by McCollum, are absent from the food for a long time, an inhibition of growth will occur and the conditions which I have termed Dystrophia alipogenetica will finally appear. This condition involves a great susceptibility and lowered resistance to all infections and often leads to xerosis of the conjunctivae and corneae associated with night blindness. The xerosis has a great tendency to result in keratomalacia. In its first stage xerophthalmia resembles a slight conjunctivitis; the children develop photophobia, their eyes are red and there is a slight secretion.
3. Xerophthalmia generally occurs in spring, the time when growth is at its maximum.
4. The disease is most frequent amongst the children of the poorest country folk and is always due to an unsuitable artificial diet, generally the replacing of whole milk partly or completely by centrifuged milk, butter milk or concoctions of flour. It may appear in children who have received whole milk and cream, but in that case the milk and cream have been boiled for too long a time or have been subjected to other kinds of drastic treatment which have destroyed the specific lipoid bodies.
5. Xerophthalmia is easily when recognised in time. The best treatment is cod liver oil, but whole milk and probably cream, butter, eggs and other fats containing the specific lipoid bodies are also curative. It is important to remember that these foods should only be subjected to the ordinary short boiling.
6. The disease is fairly common in Denmark, apparently more so than in other countries. It is, for instance, practically unknown in Sweden and Norway. According to Mori's statistics it used to be rare in Germany. The reason for its being so frequent in Denmark is probably partly due to the fact that this country exports most of its dairy produce, especially butter.
7. Many of the cases of blindness and leucoma attributed to eye complaints during infancy, are perhaps due to xerophthalmia. Of late it has been said that blindness amongst children in Denmark is increasing while gonorrhoeal ophthalmia in new born infants at the maternity hospital is decreasing. Ophthalmo-blenorrhoea has been the cause of blindness in very few of the recent admissions to the blind institute, all of which supports my contention that xerophthalmia is the actual cause of the large number of blind children in Denmark.
Contributors
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- By Katherine J. Aitchison, Louis Appleby, John Bancroft, Aaron T. Beck, Sidney Bloch, Marc B. J. Blom, Roger Bloor, Anne Buist, Alistair Burns, E. Jane Byrne, Paul Carey, David J. Castle, Alex Cohen, Michael Craig, Ilana B. Crome, Kimberlie Dean, Tom Fahy, Anne E. Farmer, Michael Farrell, Alan J. Flisher, Glen O. Gabbard, Ragy R. Girgis, Sir David Goldberg, Ian M. Goodyer, Wayne Hall, Edwin Harari, Anthony Holland, Matthew Hotopf, Assen Jablensky, Navneet Kapur, Shitij Kapur, Kenneth S. Kendler, Sean Lennon, Jeffrey A. Lieberman, David Mamo, Peter McGuffin, Paul E. Mullen, Robin Murray, David Ndegwa, Jessica R. Nittler, Vikram Patel, Perminder Sachdev, Ulrike Schmidt, Scott A. Schobel, Jan Scott, Pak C. Sham, Dan J. Stein, Ezra Susser, Michele Tansella, Graham Thornicroft, Janet Treasure, Evangelia M. Tsapakis, André Tylee, Peter Tyrer, Jim van Os, Elizabeth Walsh, Paul Walters, Myrna M. Weissman, Simon Wessely, Marieke Wichers, Kimberly Yonkers
- Edited by Robin M. Murray, King's College London, Kenneth S. Kendler, Virginia Commonwealth University, Peter McGuffin, University of Wales College of Medicine, Simon Wessely, Institute of Psychiatry, London, David J. Castle, University of Melbourne
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- Book:
- Essential Psychiatry
- Published online:
- 22 August 2009
- Print publication:
- 18 September 2008, pp vii-xi
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