Neuropathic Pain
Conditions
Keywords
Neuropathic Pain, repetitive transcranial magnetic stimulation (rTMS)
Brief summary
The repetitive transcranial magnetic stimulation (rTMS) is used in pain treatment for several years. The aim of the study is to assess, in a rigorous scientific protocol, analgesic effect of the neuronavigated rTMS assisted by robotic arm on chronic neuropathic painful subjects. The crossover study is randomized, double blinded and controlled (sham rTMS) and it includes a large homogeneous population suffering of central neuropathic pain.
Detailed description
The repetitive transcranial magnetic stimulation (rTMS) is used in pain treatment for several years. The latest meta-analysis showed that rTMS has not prove its scientific efficacy. It could be explained by several reasons: poor methodologic quality, stimulations parameters, technologic hardware, ... The aim of the study is to assess, in a rigorous scientific protocol, analgesic effect of the neuronavigated rTMS assisted by robotic arm on chronic neuropathic painful subjects. The crossover study is randomized, double blinded and controlled (sham rTMS) and it includes a large homogeneous population suffering of central neuropathic pain. The stimulated region is the primary motor cortex with high frequency (20Hz). This study has two periods (real and sham) of 12 weeks with four sessions of stimulation per period and 8 weeks of washout between the two.
Interventions
DEVICEactive rTMS then sham rTMS
A first period during which the patient will have 1 session of active rTMS every 3 weeks for 3 months A 2nd period during which the patient will have 1 session of sham rTMS every 3 weeks for 3 months
DEVICEsham rTMS then active rTMS
A first period during which the patient will have 1 session of sham rTMS every 3 weeks for 3 months A 2nd period during which the patient will have 1 session of active rTMS every 3 weeks for 3 months
Sponsors
Centre Hospitalier Universitaire de Saint Etienne
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Central neuropathic pain * Chronic pain with an average pain intensity is greater than or equal to 40/100 * Pain presents a daily or almost daily (at least 4 days out of 7) * Pain presents for more than 6 months * Patients who signed informed consent, * Patients whose pain medication is stable for 15 days before to inclusion, and will not need to be modified for the duration of the study, * Patients can be monitored for the duration of the study (29 weeks) * Patients affiliated to a health insurance plan or entitled, * Patients with a cerebral MRI T1.
Exclusion criteria
* Labor dispute or Accident, * Contraindication to rTMS (treatment with electroconvulsive therapy during the previous month, epilepsy and / or a history of epilepsy, history of head trauma, neurosurgical injury; intracranial hypertension metal clip; pacemaker pregnant or lactating women) * Abuse of drugs or psychoactive substances * Peripheral Neuropathic Pain, * Neuropathic pain within the framework of a progressive disease (HIV, cancer, non-stabilized system disease) * Intermittent pain, * Pain in less than 6 months, * Presence of other pain more severe than that justify inclusion, * Lack of stability pain scores on two successive evaluations, defined as a change of more than 30% between the two assessments of the average pain between the first two visits (inclusion and first session) * Patients unable to understand informed consent, under guardianship, * Patients refusing to stop or can not stop the prohibited treatment during the study, * Patients participating in another research protocol involving a drug within 30 days before inclusion.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of pain relief (0%= no pain relief and 100% complete pain relief ) | 3 weeks later the last session of rTMS (active ) so week n°12 | Percentage of pain relief compared to the beginning of the period of the study before the first stimulation |
| Percentage of pain relief (0%= no pain relief and 100% complete pain | 3 weeks later the last session of rTMS (sham) so week n°29. | Percentage of pain relief compared to the beginning of the period of the study before the first stimulation |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage relief of pain before each session compared to the previous meeting (or weeks number: 3, 6, 9, 12 and 20, 23, 26, 29) | before each session (or weeks number: 3, 6, 9, 12 and 20, 23, 26, 29) | — |
| Neuropathic dimension | at each session (or weeks number: 0, 3, 6, 9, 12 and 17, 20, 23, 26, 29) | specific paper questionnaire of neuropathic pain NPSI at each session (or weeks number: 0, 3, 6, 9, 12 and 17, 20, 23, 26, 29) |
| Intensity of average pain assess by a visual analogue scale (VAS) of 100 mm (0= no pain and 100= worst pain imaginable ). | 3 weeks after the last sessions of rTMS (real or sham), so week n°12 and n°29. | — |
| Consumption of analgesic treatment | 3 weeks before the first session of the period and week : 3, 6, 9, 12 and 20, 23, 26, 29 | — |
| - Percentage of responders to the treatment real rTMS: subjects whom the Percentage of pain relief at the end of each period of 4 sessions (weeks n°12 and 29) is at least 15%. | at the end of each period of 4 sessions (weeks n°12 and 29) | — |
| Intensity of average pain with VAS before each session compared to the previous meeting (or weeks number: 3, 6, 9, 12 and 20, 23, 26, 29) | before each session (or weeks number: 3, 6, 9, 12 and 20, 23, 26, 29) | — |
Countries
France
Outcome results
None listed