Effect of Transmagnetic Stimulation on Conditioned Pain Modulation (CPM)

Not Applicable

Completed

• Conditions: Migraine; Headache

• Registration Number: NCT01501045
• Lead Sponsor: Rambam Health Care Campus

Brief Summary

While some indications of the neural circuits involved in the Conditioned Pain Modulation (CPM) process are now available, there is still need to clarify what parts of the brain are essential for this process, whether the spino-brainstem loop is largely sufficient to explain CPM or whether other cerebral and spinal regions such as frontal, somatosensory and other cortical regions contribute substantially. Whereas mere observation of correlation between these circuits while activated by brain imaging is still of considerable interest, direct experimental manipulations by repetitive transcranial magnetic stimulation (rTMS) could even establish insights into causal relationships.

Detailed Description

rTMS of different intensities, frequencies and location will be applied during CPM to evaluate the central mechanisms of pain modulation, their location and role in pain reduction through enhancement or suppression of activity in the relevant brain regions. In other words, cortical regions that may be implicated in CPM will be determined by augmenting or interrupting their activity via rTMSapplied to the areas under investigation. The regions will be the pain network sites, which are assumed to control the top-down influence on CPM and are superficial enough to be stimulated by the magnetic coil. These include primarily DLPFC (dorsolateral prefrontal cortex) and OFC (orbitofrontal cortex), with possible later addition of other relevant sites such as ACC (anterior cortex cinguli), insula and somatosensory cortices, etc. Since rTMS may be administered in a manner that either reduces or enhances the excitability of the stimulated cortical region, it should be possible to clarify the inhibitory or excitatory role of these regions in the CPM process. In summary, the planned studies should allow for identifying the cortical regions of the descending pain system, which are critical as starting points for the top-down modulation of CPM.

Study Timeline

• Study Start: 2011-01
• Study First Submitted: 2011-12-12
• Study First Submitted QC: 2011-12-28
• Study First Posted: 2011-12-29
• Primary Completion: 2017-11-06
• Study Completion: 2017-11-06
• Status Verified: 2019-03
• Last Update Submitted: 2019-03-26
• Last Update Posted: 2019-03-27

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 94

Inclusion Criteria

• age 18-70
• males and females
• right handed

Exclusion Criteria

• metal in brain/skull
• cardiac pacemaker
• cohlear implants
• history of head trauma
• history of epilepsy or seizures
• pregnancy

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
Amplitude of pain-evoked potentials	1 week	Change in pain evoked potentials will be assessed before and after the TMS
Pain scores as measured by pain numerical scale (NPS)	1 week	TMS directed to pain inhibitory cortical areas will evoke pain reduction

Secondary Outcome Measures

Name	Time	Method
conditioned pain modulation (CPM)	1 week	Change in the efficiency of CPM will be assessed in response to TMS

Trial Locations

Locations (1)

The lab of clinical neurophysiology, the faculty of medicine, Technion and Rambam Medical Center; 🇮🇱 Haifa, Israel