Transcranial Magnetic Stimulation for Chronic Neuropathic Pain

Launched by UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · Oct 20, 2022

Keywords

ClinConnect Summary

This clinical trial is investigating a treatment called repetitive transcranial magnetic stimulation (rTMS) for people suffering from chronic neuropathic pain, which is a type of pain caused by issues in the nervous system and can be challenging to manage. The trial aims to see if high-frequency rTMS, which uses magnetic pulses to stimulate the brain, can help reduce pain for those who have not found relief with other medications. Researchers will also use brain imaging to explore other potential areas of the brain that could be targeted if participants do not respond to the initial treatment.

To participate in this study, individuals must be between 18 and 80 years old and have chronic neuropathic pain that has lasted for more than six months. They should also currently be taking pain medications but still experiencing significant pain. Those with certain neurological or psychiatric conditions, recent brain surgery, or specific medical devices in their body may not be eligible. Participants can expect to undergo several sessions of rTMS and will be monitored throughout the study to assess how well the treatment works for them. This trial is an opportunity to explore a new approach to managing pain that could lead to better outcomes for many individuals.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• * Meets Criteria for Chronic Neuropathic Pain (NP):
• • 1. "Pain caused by a lesion or disease of the somatosensory nervous system
• • 2. Intractable pain longer than 6 months after pain onset
• • 3. Baseline VAS score 30-94-mm
• • 4. Currently prescribed pain medication for NP, history of prior medication trials without adequate pain control, or refused treatments for individual reasons
• • 5. Continuous pain in face and/or extremities
• • Age 18-80
• • Any gender and all ethnoracial categories
• • Stable on chronic pain medications for 4 weeks prior to the study and agreeable to continue throughout the study. These medications include: Tricyclic antidepressants (e.g., nortriptyline, amitriptyline), SNRIs (e.g., duloxetine, venlafaxine), gabapentinoids (e.g., gabapentin, pregabalin), antiepileptics (e.g., valproic acid, carbamazepine, lamotrigine), and daily anti-inflammatories (e.g., meloxicam), among others (as determined by study physician at the time of screening). Note: Medications that are known to increase cortical excitability (e.g., buproprion, maprotiline, tricyclic antidepressants, classical antipsychotics) or to have an inhibitory effect on brain excitability (e.g., antiepileptics, benzodiazepines, and atypical antipsychotics), or any other medications with relative hazard for use in TMS will be allowed upon review of medications and/or motor threshold determination by TMS specialist.
• • Participants may continue to take as-needed pain medications and record daily usage throughout the experiment
• • Capacity to provide informed consent
• • Ability to tolerate study procedures
• • Successfully complete the screening forms without contraindications
• Exclusion Criteria:
• • Neurologic: Dementia, Severe neurocognitive disorder (MoCA \< 22), Severe aphasia, Seizure disorder, certain structural brain lesions (e.g., intracranial mass lesions, hydrocephalus, sequelae of meningitis), or complete paralysis at target site
• • Psychiatric: DSM Axis I disorder, Suicidal thoughts, prior psychosurgery, prior ECT
• • Procedural: prior rTMS within 1 year of consent, enrollment in other clinical trial in the past 6 months
• • TMS contraindications: implanted device; presence of metal in the head, including eyes and ears (excluding dental implants); certain tics; medications or systemic illness that predispose seizure risk
• • Participants with an unstable physical, systemic, or metabolic disorder (e.g., unstable hypertension, cardiac disease)
• • Females who are pregnant or nursing
• • Inability to complete the research study