Transcranial magnetic stimulation and symptom management in palliative care

Background: Transcranial magnetic stimulation (TMS) is a non-invasive neurostimulation technique currently approved by the Food and Drug Administration for the treatment of depression, migraines with aura and obsessive-compulsive disorder. While there is ample evidence supporting the safety and efficacy of TMS in treating these conditions, there is limited exploration of the application of TMS in the context of palliative care. Methods: In the wake of a preliminary study of 'accelerated' repetitive TMS promising symptomatic improvement in depression and anxiety in palliative care patients, we evaluated the use of TMS in addressing a broad spectrum of palliative care-focused symptoms based on the Edmonton Symptom Assessment System (ESAS) in numerous studies. Results: Positive effects were observed in modulating depression, anxiety, sleep, dyspnoea, appetite, peripheral neuropathy, non-neuropathic pain, fatigue and feelings of well-being. Although cachexia and nausea are symptoms classified under the ESAS, our literature search yielded no search results regarding TMS treatment. Conclusion: Larger-scale clinical studies with diverse samples are warranted, and future exploration is necessary to discover additional methodologies for TMS therapy. In this narrative review article, we discuss the current studies to analyse the supporting data, efficacy, safety, mechanisms and the therapeutic potential of TMS use across various conditions within palliative care.