Developing Brain Stimulation as a Treatment for Chronic Pain in Opiate Dependent Individuals

Developing Brain Stimulation as a Treatment for Chronic Pain in Opiate Dependent Individuals

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).

Concepts Keywords
ADHD ADHD
Aim Chronic migraines
Analgesic Severe chronic pain
Anterior Cingulate Obsessive compulsive disorder
Anti Seizure Medications Anti seizure
Bipolar Affective Disorder History seizures
Birth Control Disorders psychotic disorder
Brain Chronic opiates
Chronic Pain Medications lower seizure
Civil War Brain pain
Claustrophobia Back pain
Clinical Anxiety Head injury
Clinical Trial Organic mental disorder
Cohort Birth control
Consciousness Neuroscience
Default Mode Network Perception
Depression Cerebral cortex
Dorsal Acute pain
Dorsolateral Prefrontal Cortex Nociception
Double Blind Neurotechnology
DSM Electrotherapy
DUI Dorsolateral prefrontal cortex
Eating Disorders Transcranial magnetic stimulation
Epidural Chronic pain
Factor Analysis Default mode network
Frequency Neuroscience
Heroin Control Network
Hospital MRI
Informed Consent
Insula
Intravenous
Latin Square
LTP
Marijuana
Medial Prefrontal Cortex
Mental Disorder
Migraines
Morphine
MRI
Multivariate
Naloxone
Narcotics
Neuroscience
Nicotine
Nursing
Obsessive Compulsive Disorder
Opiate
Opiates
Overdose Deaths
Pain
Parametrically
Pharmacological
Prescribed Medications
Psychoactive
Psychotic Disorder
Randomization
RTMS
Schizophrenia
Seizure
Seizures
Somatosensory
Subarachnoid Hemorrhage
Suicidal Ideation
Thalamus
Transcranial Magnetic Stimulation
Traumatic Brain Injury
United States
Urine
Urine Drug Screen
Ventral
Violent Crime
Wake Forest

Semantics

Type Source Name
disease MESH Chronic Pain
disease MESH lower back pain
gene UNIPROT EHD1
drug DRUGBANK Diamorphine
gene UNIPROT CD69
gene UNIPROT DNMT1
disease MESH community
gene UNIPROT CTBS
drug DRUGBANK Tilmicosin
gene UNIPROT RENBP
disease MESH seizures
disease MESH loss of consciousness
disease MESH subarachnoid hemorrhage
disease MESH claustrophobia
disease MESH anxiety
disease DOID anxiety
drug DRUGBANK Medical Cannabis
drug DRUGBANK Nicotine
disease MESH obsessive-compulsive disorder
disease DOID obsessive-compulsive disorder
disease MESH schizophrenia
disease DOID schizophrenia
disease MESH disorders eating
disease MESH psychotic disorder
disease DOID psychotic disorder
disease MESH organic mental disorder
disease DOID organic mental disorder
disease MESH suicidal ideation
disease DOID ADHD
drug DRUGBANK Chorionic Gonadotropin (Human)
disease MESH migraines
gene UNIPROT NR4A2
gene UNIPROT ALG3
disease MESH Back Pain

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