Comparing Accelerated Intermittent Theta Burst Stimulation and Traditional High-frequency Repetitive Transcranial Magnetic Stimulation for Chronic Neuropathic Pain Relief with Response Prediction

What this Trial Is About

Researchers are evaluating two non-invasive brain stimulation techniques, high frequency repetitive transcranial magnetic stimulation rTMS and accelerated intermittent theta burst stimulation aiTBS, to reduce chronic neuropathic pain lasting at least 6 months. This randomized controlled trial with a crossover design compares these methods to sham stimulation, aiming to assess their analgesic effects and identify factors predicting treatment response. The study includes adults aged 18 to 80 with neuropathic pain and uses brain stimulation targeting pain-related brain regions. The trial involves two treatment phases where participants receive either active or sham stimulation. Active rTMS consists of 5 daily sessions over 5 consecutive days, each lasting 25 to 30 minutes with 1500 pulses per session. Active aiTBS delivers 5 sessions in a single day with breaks between sessions, each lasting about 8 minutes and also delivering 1500 pulses per session. Sham stimulation mimics the active treatments but uses an inactive coil face and low-intensity electrical stimulation to maintain blinding. A 4 to 6-week washout period separates the two treatment phases. Participants undergo about 11 to 12 in-person visits over 10 to 12 weeks. Assessments include self-reported pain diaries using the numeric pain rating scale, validated questionnaires on pain and quality of life, resting-state EEG, and transcranial magnetic stimulation measures of brain excitability. Researchers monitor changes in pain intensity and other outcomes from before treatment through three weeks after treatment. The study also explores neurophysiological and clinical predictors to personalize chronic pain treatment.

aiTBS and rTMS in Neuropathic Pain and Prediction of Response