Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Master of Science

Program

Neuroscience

Supervisor

Schabrun, Siobhan

2nd Supervisor

Loh, Eldon

Co-Supervisor

Abstract

Chronic axial pain (CAP) is a debilitating condition impacting millions globally, with traditional treatments providing only short-term relief. This pilot study explored the primary outcomes of feasibility, tolerability, and safety, as well as the secondary outcomes of pain intensity, disability, quality of life, and patients’ perceived response to the combined intervention of repetitive transcranial magnetic stimulation (rTMS) and corticosteroid joint injections (CJI) as a novel approach to address CAP. Sixteen participants from St. Joseph’s Healthcare Pain Clinic were randomized (1:1) to receive 11 active or sham rTMS sessions over 12 weeks, with follow-up until week 24 or their next CJI, whichever came first. Feasibility was assessed through dropout rates, session and assessment completeness, and screening-to-enrollment ratios. Tolerability was rated on a 1-5 scale, and safety was assessed based on reported adverse effects. Although secondary outcomes showed no significant differences between the treatment groups, the results support the feasibility, tolerability, and safety of combining rTMS with CJI, warranting a larger clinical trial to explore the question of clinical efficacy.

Summary for Lay Audience

Chronic axial pain (CAP), such as lower back and neck pain, is a serious issue affecting many people worldwide. It is one of the main reasons why people visit the emergency room, placing a huge burden on the healthcare system. Even though several interventions are currently used to manage this condition, they are only effective for short-term pain relief and have some side effects. As this condition is very common, there is a need to provide a more lasting treatment with little to no side effects.

This thesis was conducted to assess a new form of intervention that combines two different approaches. The first approach is an existing treatment used in pain clinics to provide pain relief for patients with CAP. These patients received an injection containing steroids, which helped reduce swelling and pain in the joint. However, we know that this injection can help reduce pain for only a few weeks at a time. The second approach is to noninvasively stimulate the brain areas involved in processing how pain is experienced using magnetic energy. Evidence shows that the way the brain processes pain changes when people experience chronic pain. Even after the cause of pain is treated, the brain can still interpret body signals as painful. Although this approach has shown promise in reducing pain, there is no standard treatment protocol for its use in clinical practice.

We conducted 11 sessions of brain stimulation after the participants received regular steroid injections and monitored them for 24 weeks. We randomly chose participants to receive either real or fake brain stimulation to determine whether there was a true treatment effect without any bias. We found that this combined approach is generally tolerable and safe. We were unable to show that the combined intervention was better than injection alone. This was likely due to the small number of participants in the study. This study is important because we targeted pain at the source and from the brain, which is better than the available treatments that only focus on treating pain at its source.

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

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