Using Hypnosis to Alleviate Pain During rTMS: A Case Report

Repetitive transcranial magnetic stimulation (rTMS) is generally well tolerated, with few or no side effects. However, some patients may experience unpleasant sensations such as mild to moderate pain during scalp stimulation. For these patients, any discomfort or pain associated with the procedure may have a negative impact on therapeutic adherence. Hypnosis could offer an interesting option for alleviating pain or discomfort associated with rTMS. We present the case of a patient treated with rTMS, for whom the intensity of stimulation was difficult to tolerate from the first session due to headaches. To alleviate this discomfort, we offered this patient concomitant hypnosis with rTMS. Starting on the third day of the treatment program, Ericksonian hypnosis was carried out over the remaining 7 days, with self-hypnosis gradually replacing the therapist's intervention. Hypnosis was conducted 5 minutes before the start of the stimulation sessions. Visual analog scales were used to assess pain and anxiety, before and during rTMS sessions. The visual analog scale score dropped from 8.5 to 3 for pain and from 5 to 3 for anxiety before and during a session. Stimulation intensity, initially reduced due to pain felt by the patient, was increased back to its original level. Combining hypnosis with rTMS not only reduced the patient's perception of pain, but also improved her tolerance to the intensity of stimulation, enabling her to complete the treatment program in greater comfort. Beyond pain management, hypnosis could also have a potentiating effect on rTMS.