Publication date: Nov 08, 2019
Effective control of chronic pain is a top priority in the United States, as approximately 10% of adults have severe chronic pain most of which is chronic lower back pain (CLBP). However, despite the advances in neuroscience over the past 20 years, chronic pain is largely treated with opiate narcotics, much as was done in the Civil War. In addition to their high abuse liability and dependence potential (1), only 30 40% of chronic pain patients declare they receive satisfactory (>50%) relief from their pain through pharmacological treatment (Attal et al., 2006). In these patients a common clinical practice is to escalate the dose of opiates as tolerance develops which unfortunately has contributed to escalation in opiate overdose deaths (2), a resurgence of intravenous heroin use, and $55 billion in societal costs (3). Consequently there is a critical need for new, treatments that can treat pain and reduce reliance on opiates in individuals with chronic pain. The proposed study will be the first to employ a randomized, double-blind, sham-controlled design to parametrically evaluate the longitudinal effects of 16 days of rTMS to the DLPFC (Aim 1) or the MPFC (Aim 2) on self-reported pain and the brain s response to pain. This will be done in a cohort of patients recruited from the community as well as WFUHS clinics with chronic lower back pain that have not been able to find adequate pain relief, whether or not they are using prescription opiates for 3 or more months. Participants will be randomized to receive rTMS to the DLPFC (iTBS), MPFC (cTBS), or sham (50% at each site), using a Latin square randomization. Resting state connectivity will be collected 3 times: before the 1st day of TMS, after the 12th day of TMS, and before the 16th day of TMS (the last day administered).
|disease||MESH||lower back pain|
|disease||MESH||loss of consciousness|
|disease||MESH||organic mental disorder|
|disease||DOID||organic mental disorder|
|drug||DRUGBANK||Chorionic Gonadotropin (Human)|
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