Exploring patient perceptions of repetitive transcranial magnetic stimulation as a treatment for chronic musculoskeletal pain : a qualitative study

![CDATA[Background and Aims: Repetitive transcranial magnetic stimulation (rTMS), a form of non-invasive brain stimulation, represents a novel treatment for the management of chronic musculoskeletal pain. Despite evidence supporting the safety and effectiveness of rTMS in chronic musculoskeletal pain conditions, the clinical uptake of rTMS for the treatment of pain remains limited. One plausible reason for this may be a lack of understanding regarding patient perceptions and willingness to engage with this intervention. Understanding patient perceptions of rTMS is an essential step in determining its clinical utility. Therefore, this study aimed to explore patient perceptions of rTMS as a treatment for chronic musculoskeletal pain. Methods: A phenomenological perspective was adopted for this qualitative study. All participants were required to have a diagnosis of chronic musculoskeletal pain, had a history of seeking treatment, and had no prior experience with rTMS. In order to capture initial perceptions of rTMS, a visual image of the rTMS set-up and a brief explanation of the intervention was first provided to participants. This was followed by a semi-structured interview where perceptions were explored. The interviews included questions related to knowledge of rTMS, pre-conceived concerns and expectations of rTMS, and the overall attitudes towards accepting rTMS as a treatment option for chronic musculoskeletal pain. The interviews were transcribed verbatim and then analysed thematically. Results: The study included 15 participants, ranging from ages 18 to 61 years. The majority of participants had experienced chronic pain for longer than one year. Overall, participants were willing to consider the use of rTMS as a treatment option, with most having high expectations regarding the effectiveness of the treatment due to its sophisticated appearance. Funding and accessibility were the two main barriers to use of rTMS. Concerns over the safety of rTMS and the associated side effects were not consistently shared across all participants. Conclusions: Patients with chronic pain were willing to consider the use of rTMS as a treatment option, with the majority having high expectations regarding the effectiveness of the treatment. The need to have funding support and accessibility of treatment appeared to be the key considerations. These findings can assist future researchers to develop targeted strategies to encourage uptake of rTMS in a clinical chronic pain setting.]]