TMS for Neuropathic Pain
What You Need to Know Before You Apply
What is the purpose of this trial?
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.
Do I have to stop taking my current medications for the trial?
No, you don't have to stop taking your current medications. You need to be stable on your chronic pain medications for 4 weeks before the study and continue them throughout the study. Some medications will be reviewed by a TMS specialist to ensure they are safe to use with TMS.
What safety data exists for TMS in treating neuropathic pain?
The safety data for TMS in treating neuropathic pain indicates that it is generally well-tolerated. In a randomized, multicenter, double-blind, crossover, sham-controlled trial, no serious adverse events were observed with daily high-frequency rTMS of the primary motor cortex. This suggests that TMS is a safe treatment option for neuropathic pain, although the analgesic effects are modest and transient.12345
Is the treatment High Frequency rTMS promising for neuropathic pain?
Yes, High Frequency rTMS is a promising treatment for neuropathic pain. It can relieve pain by stimulating the brain non-invasively, and studies show it can provide long-lasting pain relief. It is already approved for treating depression and has shown effectiveness in small studies for neuropathic pain.23678
What data supports the idea that TMS for Neuropathic Pain is an effective treatment?
The available research shows that repetitive transcranial magnetic stimulation (rTMS) can effectively relieve neuropathic pain. Studies indicate that high-frequency rTMS applied to specific brain areas can reduce pain. For example, a meta-analysis found that rTMS is more effective for pain that originates in the central nervous system compared to pain from peripheral nerves. Additionally, research suggests that rTMS may work by releasing natural pain-relieving chemicals in the brain. Overall, these findings support the idea that TMS is a promising treatment for neuropathic pain.256910
Who Is on the Research Team?
Julian C Motzkin, MD/PhD
Principal Investigator
University of California, San Francisco
Prasad Shirvalkar, MD/PHD
Principal Investigator
University of California, San Francisco
Are You a Good Fit for This Trial?
This trial is for adults aged 18-80 with chronic neuropathic pain lasting over 6 months due to nerve damage or disease. Participants must have a certain level of continuous pain, be able to tolerate the procedures, and give informed consent. They should be stable on their current pain medications and not pregnant, nursing, or have specific psychiatric conditions or contraindications for TMS.Inclusion Criteria
Exclusion Criteria
Timeline for a Trial Participant
Screening
Participants are screened for eligibility to participate in the trial
Treatment
Participants receive daily rTMS sessions for 10 consecutive weekdays
Optional Extension
Participants may receive additional stimulation at the same or new target region
Follow-up
Participants are monitored for safety and effectiveness after treatment
What Are the Treatments Tested in This Trial?
Interventions
- High Frequency rTMS
- Low Frequency rTMS
High Frequency rTMS is already approved in United States for the following indications:
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Who Is Running the Clinical Trial?
University of California, San Francisco
Lead Sponsor