Long-term effects of rTMS in chronic neuropathic pain in people with SCI

Objective: This project will evaluate the efficacy of rTMS on long-term improvement in pain symptoms for CNP and cortical excitability changes underlying the analgesic effects produced by the brain stimulation. This could represent a potentially valuable long-term clinical approach for the treatment of CNP following SCI. At the completion of the research, we expect to have determined a set of strategies that optimize the analgesic efficacy of rTMS therapy in SCI survivors (Aim 1), and to have identified key behavioral and physiological features that may ultimately predict therapeutic response to rTMS (Aim 2). This work will have a strong positive impact in establishing TMS as a non-invasive and non-pharmacological treatment option for neuropathic pain.

Criteria: Thirty individuals with chronic cervical SCI lesions and presence of CNP in their upper extremity will be enrolled in the study. Pain should not have any primary relation to spasms or any other movement and must have started after the SCI, been present for at least 6 months, and be unresponsive to medication.

Inclusion criteria include: a) presence of chronic neuropathic pain at or below SCI level for at least 6 months following trauma or disease of the spinal cord; b) cervical lesion; c) CNP in the upper extremity; d) pain intensity of at least 4 out of 10 in the numerical rating scale (NRS) in the NPS at both screening (baseline) and randomization (pre-evaluation); d) stable pharmacological treatment for at least 2 weeks prior to the study and throughout the trial; e) complete or incomplete lesion. Participants will be excluded if they present: a) presence of severe pain of other origin, such as musculoskeletal pain; b) psychiatric or other neurological disorders; c) presence of potential risk factors for brain stimulation (TMS): history of seizures, presence of surgically implanted foreign bodies such as a pacemaker, metal plate in the skull, or metal inside the skull; d) medically unstable.

Duration: Study participants will get the repetitive TMS protocol at the ARC daily, five consecutive days per week, for 2 weeks.
Principal Investigator: Dr. Mar Cortes, MD. Co-Investigator: Laura Tabacof, MD
Dates: 2020 – 2022
Contact: abilitiesresearchcenter@mountsinai.org | Phone: (212) 824 – 8369

Website: https://icahn.mssm.edu/research/abilities-research-center/research/current