Transcranial Magnetic Stimulation for Chronic Neuropathic Pain

Running, not enrolling · Not applicable

Conditions studied: Chronic Neuropathic Pain, Post-Stroke Pain, Trigeminal Neuralgia, Nerve Injury, Spinal Cord Injuries, Pain, Postoperative, Complex Regional Pain Syndromes, Post-herpetic Neuralgia, Nerve Root Avulsion

In brief

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.

Key facts

Study ID: NCT05593237
Run by: University of California, San Francisco
People needed: 32
Starts: 2022-04-25
Expected to finish: 2026-12-30
Last updated by the study team: 2026-03-13

Who can join

Age: 18 and older, up to 80. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

Meets Criteria for Chronic Neuropathic Pain (NP):
"Pain caused by a lesion or disease of the somatosensory nervous system
Intractable pain longer than 6 months after pain onset
Baseline VAS score 30-94-mm
Currently prescribed pain medication for NP, history of prior medication trials without adequate pain control, or refused treatments for individual reasons
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

You may not qualify if…

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

Where it is running

UCSF Medical Center — San Francisco, California, United States

Full record on ClinicalTrials.gov

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