Reviewed by Michael Gill, B. Sc.
Image of UCSF Medical Center in San Francisco, United States.
Phase-Based Progress Estimates
1
Effectiveness
1
Safety

High Frequency RTMSfor Pain

18+
All Sexes
Chronic neuropathic pain is defined as pain caused by a lesion or disease of the somatosensory nervous system. It is highly prevalent, debilitating, and challenging to treat. Current available treatments have low efficacy, high side effect burden, and are prone to misuse and dependence. Emerging evidence suggests that the transition from acute to chronic neuropathic pain is associated with reorganization of central brain circuits involved in pain processing. Repetitive transcranial magnetic stimulation (rTMS) is a promising alternative treatment that uses focused magnetic pulses to non-invasively modulate brain activity, a strategy that can potentially circumvent the adverse effects of available treatments for pain. RTMS is FDA-approved for the treatment of major depressive disorder, obsessive-compulsive disorder, and migraine, and has been shown to reduce pain scores when applied to the contralateral motor cortex (M1). However, available studies of rTMS for chronic neuropathic pain typically show variable and often short-lived benefits, and many aspects of optimal treatment remain unknown, including ideal rTMS stimulation parameters, duration of treatment, and relationship to the underlying pain etiology. Here the investigators propose to evaluate the efficacy of high frequency rTMS to M1, the region with most evidence of benefit in chronic neuropathic pain, and to use functional magnetic resonance imaging (fMRI) to identify alternative rTMS targets for participants that do not respond to stimulation at M1. The central aim is to evaluate the pain relieving efficacy of multi-session high-frequency M1 TMS for pain. In secondary exploratory analyses, the investigator propose to investigate patient characteristic that are predictive of responsive to M1 rTMS and identify viable alternative stimulation targets in non-responders to M1 rTMS.
Waitlist Available
Has No Placebo
UCSF Medical CenterJulian C Motzkin, MD/PhD
10 Trigeminal Neuralgia Clinical Trials Near Me
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Toronto Western Hospital, University Health Network
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What are Trigeminal Neuralgia Clinical Trials?

Trigeminal Neuralgia (TN) is a chronic neurological condition that causes severe, sudden, short pain in the lower part of the face. It is caused by squeezing the trigeminal nerve by blood vessels nearby that press it against the skull. The pain caused by this compression is unpredictable and can last from a few seconds to a few minutes. It is described as an electric shock in the teeth, gums, and jaw.

TN attacks can happen regularly for any period and, in severe cases, as many as a hundred times a day. Pain attacks may disappear for some months or years but will come back without warning. As this condition progresses, it may lead to continuous aching and burning sensation in the lower face, along with sudden, sharp pain.

TN is difficult to live with, significantly affecting a person's quality of life. Many suffer from anxiety, stress, fear, and panic at the thought of impending pain attacks. These emotions often result in isolation, weight loss, depression, and suicidal thoughts.

Why Is Trigeminal Neuralgia Being Studied Through Clinical Trials?

Estimates suggest that at least 1 in 8,000 people suffers from Trigeminal Neuralgia (TN). It is more common in women and usually develops in people over 50. However, many cases have been reported in children and young adults, particularly those who already have multiple sclerosis.

Even though it is considered rare, clinical trials for TN are vital because of their extremely detrimental toll on a person’s life. It is often misdiagnosed, and someone can suffer for years before they are given the right medication to manage it.

Currently, one of the biggest problems with TN treatments is that they are not permanent, and pain attacks often return. Many studies now focus on the long-term effects of treatments and if they improve the quality of life of people with TN.

What Treatment is Available for Trigeminal Neuralgia?

Current treatment options for Trigeminal Neuralgia include medication, surgery, and alternative therapies.

Anti-seizure medicines are the most effective treatment as they block the nerves from firing. These are often given in combination with antidepressants that can numb the pain. However, these medications can prove ineffective, especially when trigeminal neuralgia (TN) progresses. In such cases, surgery is preferred and has been shown to relieve 75% of TN patients.

Surgical treatments involve performing a rhizotomy, a procedure that damages nerve fibers, or a neurectomy, where a part of the nerve is cut away. The downside to both of these is they always cause a level of facial numbness and sensory loss. Also, TN will often return even if the surgery was successful.

Alternative therapies include exercise, meditation, acupuncture, and diet therapy. But there is not enough evidence to substantiate their effectiveness.

What are Some Recent Trigeminal Neuralgia Clinical Trial Breakthroughs?

2017: New studies have found that using nasal spray applicators was more effective at suppressing neurotransmitters in the ganglion area, thereby reducing the overall pain in trigeminal neuralgia faster and more effectively.

2019: This review suggests that local botulinum neurotoxin injections with a sodium channel blocker can paralyze the trigeminal nerve. It also provides evidence of more reliable surgical methods, such as Gamma knife surgery.

About The Author

Michael Gill preview

Michael Gill - B. Sc.

First Published: October 14th, 2021

Last Reviewed: November 28th, 2022

Michael Gill holds a Bachelors of Science in Integrated Science and Mathematics from McMaster University. During his degree he devoted considerable time modeling the pharmacodynamics of promising drug candidates. Since then, he has leveraged this knowledge of the investigational new drug ecosystem to help his father navigate clinical trials for multiple myeloma, an experience which prompted him to co-found Power Life Sciences: a company that helps patients access randomized controlled trials.

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