search
Back to results

Accelerated Theta Burst in Chronic Pain: A Biomarker Study

Primary Purpose

Chronic Pain

Status
Not yet recruiting
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Intermittent Theta Burst Stimulation (iTBS)
Sponsored by
Stanford University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Chronic Pain focused on measuring Chronic Pain, Repetitive Transcranial Magnetic Stimulation (rTMS), Accelerated Theta Burst Stimulation (aTBS), Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT)

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Patients need to meet at least a 4/10 on a clinical pain rating scale and/or fulfill fibromyalgia diagnostic criteria on the 2010 Fibromyalgia Diagnostic Criteria (Wolfe et al., 2010)
  2. Age 18 - 70
  3. Right-handed
  4. Agree to having fMRI scans as well as rTMS sessions
  5. Proficiency in English sufficient to complete questionnaires / follow instructions during fMRI assessments and treatment
  6. Women of childbearing potential must agree to use adequate contraception prior to study entry and continue this for the duration of the study
  7. Participants may continue antidepressant regimen, but must be stable for 6 weeks prior to enrollment in the study. Antidepressant must be of the SSRI class only (if currently on a different antidepressant, patients will be switched to an SSRI). They must maintain that same antidepressant regimen throughout the study duration.

Exclusion Criteria:

  1. History of MI, CABG, CHF, or other cardiac history.
  2. Any condition that would contraindicate MRI (such as ferromagnetic metal in the body)
  3. Pregnancy or breastfeeding
  4. Any neurological condition, history of epilepsy, history of rTMS failure with FDA approved rTMS parameters, history of any implanted device or psychosurgery for depression, history of receiving ECT. OCD, narcolepsy or any additional significant neurological disorder as determined by the PI.
  5. Autism spectrum disorder
  6. Inability to stop taking medication contraindicated with treatment
  7. Any significant psychiatric disorder as identified on the Mini International Neuropsychiatric Interview and determined by the PI
  8. A positive urine toxicology screen

Sites / Locations

  • Stanford University

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Active Comparator

Active Comparator

Sham Comparator

Arm Label

iTBS over L-DLPFC to dACC

iTBS over L-DLPFC to sgACC

Sham iTBS over L-DLPFC

Arm Description

Participants will receive iTBS (intermittent theta burst stimulation) to the left dorsal lateral prefrontal cortex (L-DLPFC) with high connectivity to the dorsal anterior cingulate cortex (dACC). The L-DLPFC will be targeted utilizing the Localite neuronavigation system. Stimulation intensity will be standardized at 90% of resting motor threshold adjust to the skull to cortical surface distance. Stimulation will be delivered to L-DLPFC using the MagPRo stimulator.

Participants will receive iTBS (intermittent theta burst stimulation) to the left dorsal lateral prefrontal cortex (L-DLPFC) with high connectivity to the subgenual cingulate cortex (sgACC). The L-DLPFC will be targeted utilizing the Localite neuronavigation system. Stimulation intensity will be standardized at 90% of resting motor threshold adjust to the skull to cortical surface distance. Stimulation will be delivered to L-DLPFC using the MagPRo stimulator.

Participants will receive sham iTBS (intermittent theta burst stimulation) to the left DLPFC. The L-DLPFC will be targeted utilizing the Localite neuronavigation system. Sham stimulation will be delivered to L-DLPFC using the MagPRo stimulator.

Outcomes

Primary Outcome Measures

Change in the Brief Pain Inventory (BPI) score
A self-report measure designed to enable investigators to easily obtain sensitive measures of the degree of depression and individual is experiencing. Scoring: Pain Severity Score: This is calculated by adding the scores for questions 2, 3, 4 and 5 and then dividing by 4. This gives a severity score out of 10. Pain Interference Score: This is calculated by adding the scores for questions 8a, b, c, d, e, f and g and then dividing by 7. This gives an interference score out of 10.
Change in the McGill Pain Questionnaire score
A self-report questionnaire that allows individuals that assesses the quality and intensity of pain that is experienced. The pain rating index has 2 subscales: sensory subscale with 11 words, and affective subscale with 4 words. These items are rated on an intensity scale as 0 = none, 1 = mild, 2 = moderate and 3 = severe. There's also one item for present pain intensity and one item for a 10cm visual analogue scale for average pain.

Secondary Outcome Measures

Change in the Montgomery Asberg Depression Rating Scale (MADRS) score
A ten item diagnostic questionnaire used to measure the severity of depressive episodes in patients with mood disorders. Higher MADRS score indicates more severe depression, and each item yields a score of 0 to 6. The overall score ranges from 0 to 60; 0 to 6 - normal, symptom absent; 7 to 19 - mild depression; 20 to 34 - moderate depression; >34 - severe depression.
Change in teh Hamilton Rating Scale for Depression (HAM-17) score
A provider administered questionnaire used to assess remission and recovery from depression. in general the higher the total score the more severe the depression. HAM-D score level of depression: 10-13 mild; 14-17 mild to moderate; >17 moderate to severe.
Change in the Pain Catastrophizing Scale (PCS) score
A self-report measure, consisting of 13 items scored from 0 to 4, resulting in a total possible score of 52 that measures a person's catastrophizing of pain. A higher score indicates a higher level of pain catastrophizing.
Change in functional connectivity as measured by Functional Magnetic Resonance Imaging (fMRI)
Participants will have fMRI scans both before the first treatment (baseline) and after the aiTBS course. The MRI scans will be used to identify potential biomarkers for antidepressant response and pain response, as well as identify aiTBS-induced changes in functional connectivity.

Full Information

First Posted
May 30, 2019
Last Updated
May 4, 2022
Sponsor
Stanford University
search

1. Study Identification

Unique Protocol Identification Number
NCT03984201
Brief Title
Accelerated Theta Burst in Chronic Pain: A Biomarker Study
Official Title
Accelerated Theta Burst in Chronic Pain: A Biomarker Study
Study Type
Interventional

2. Study Status

Record Verification Date
May 2022
Overall Recruitment Status
Not yet recruiting
Study Start Date
June 2023 (Anticipated)
Primary Completion Date
August 2024 (Anticipated)
Study Completion Date
August 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Stanford University

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study evaluates an accelerated schedule of theta-burst stimulation using a transcranial magnetic stimulation device for chronic pain. In this double blind, randomized control study, participants will be randomized to the treatment group to receive accelerated theta-burst stimulation or to a control group. All participants will be offered the open-label, active treatment 4 week prior to completing the initial 5 days of treatment.
Detailed Description
Repetitive transcranial magnetic stimulation (rTMS) is an established technology as therapy for treatment-resistant depression and has been utilized to treat persons suffering from chronic pain. The approved method for treatment is 10Hz stimulation for 40 min over the left dorsolateral prefrontal cortex (L-DLPFC). This methodology has been very successful in real world situations. The limitations of this approach include the duration of the treatment (approximately 40 minutes per treatment session). Recently, researchers have aggressively pursued modifying the treatment parameters to reduce treatment times with some preliminary success. This study intends to further modify the parameters to create a more rapid form of the treatment and look at the change in neuroimaging biomarkers.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Pain
Keywords
Chronic Pain, Repetitive Transcranial Magnetic Stimulation (rTMS), Accelerated Theta Burst Stimulation (aTBS), Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT)

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
Blinded, randomized control
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
60 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
iTBS over L-DLPFC to dACC
Arm Type
Active Comparator
Arm Description
Participants will receive iTBS (intermittent theta burst stimulation) to the left dorsal lateral prefrontal cortex (L-DLPFC) with high connectivity to the dorsal anterior cingulate cortex (dACC). The L-DLPFC will be targeted utilizing the Localite neuronavigation system. Stimulation intensity will be standardized at 90% of resting motor threshold adjust to the skull to cortical surface distance. Stimulation will be delivered to L-DLPFC using the MagPRo stimulator.
Arm Title
iTBS over L-DLPFC to sgACC
Arm Type
Active Comparator
Arm Description
Participants will receive iTBS (intermittent theta burst stimulation) to the left dorsal lateral prefrontal cortex (L-DLPFC) with high connectivity to the subgenual cingulate cortex (sgACC). The L-DLPFC will be targeted utilizing the Localite neuronavigation system. Stimulation intensity will be standardized at 90% of resting motor threshold adjust to the skull to cortical surface distance. Stimulation will be delivered to L-DLPFC using the MagPRo stimulator.
Arm Title
Sham iTBS over L-DLPFC
Arm Type
Sham Comparator
Arm Description
Participants will receive sham iTBS (intermittent theta burst stimulation) to the left DLPFC. The L-DLPFC will be targeted utilizing the Localite neuronavigation system. Sham stimulation will be delivered to L-DLPFC using the MagPRo stimulator.
Intervention Type
Device
Intervention Name(s)
Intermittent Theta Burst Stimulation (iTBS)
Other Intervention Name(s)
Accelerated Theta Burst Stimulation (aTBS), Repetitive Transcranial Magnetic Stimulation (rTMS)
Intervention Description
Participants will receive active or sham transcranial magnetic stimulation delivered to the L-DLPFC.
Primary Outcome Measure Information:
Title
Change in the Brief Pain Inventory (BPI) score
Description
A self-report measure designed to enable investigators to easily obtain sensitive measures of the degree of depression and individual is experiencing. Scoring: Pain Severity Score: This is calculated by adding the scores for questions 2, 3, 4 and 5 and then dividing by 4. This gives a severity score out of 10. Pain Interference Score: This is calculated by adding the scores for questions 8a, b, c, d, e, f and g and then dividing by 7. This gives an interference score out of 10.
Time Frame
Pre-treatment, immediately post-treatment
Title
Change in the McGill Pain Questionnaire score
Description
A self-report questionnaire that allows individuals that assesses the quality and intensity of pain that is experienced. The pain rating index has 2 subscales: sensory subscale with 11 words, and affective subscale with 4 words. These items are rated on an intensity scale as 0 = none, 1 = mild, 2 = moderate and 3 = severe. There's also one item for present pain intensity and one item for a 10cm visual analogue scale for average pain.
Time Frame
Pre-treatment, immediately post-treatment
Secondary Outcome Measure Information:
Title
Change in the Montgomery Asberg Depression Rating Scale (MADRS) score
Description
A ten item diagnostic questionnaire used to measure the severity of depressive episodes in patients with mood disorders. Higher MADRS score indicates more severe depression, and each item yields a score of 0 to 6. The overall score ranges from 0 to 60; 0 to 6 - normal, symptom absent; 7 to 19 - mild depression; 20 to 34 - moderate depression; >34 - severe depression.
Time Frame
Pre-treatment, immediately post-treatment, 2 weeks post-treatment, 4 weeks post-treatment
Title
Change in teh Hamilton Rating Scale for Depression (HAM-17) score
Description
A provider administered questionnaire used to assess remission and recovery from depression. in general the higher the total score the more severe the depression. HAM-D score level of depression: 10-13 mild; 14-17 mild to moderate; >17 moderate to severe.
Time Frame
Pre-treatment, immediately post-treatment, 2 weeks post-treatment, 4 weeks post-treatment
Title
Change in the Pain Catastrophizing Scale (PCS) score
Description
A self-report measure, consisting of 13 items scored from 0 to 4, resulting in a total possible score of 52 that measures a person's catastrophizing of pain. A higher score indicates a higher level of pain catastrophizing.
Time Frame
Pre-treatment, immediately post-treatment, 2 weeks post-treatment, 4 weeks post-treatment
Title
Change in functional connectivity as measured by Functional Magnetic Resonance Imaging (fMRI)
Description
Participants will have fMRI scans both before the first treatment (baseline) and after the aiTBS course. The MRI scans will be used to identify potential biomarkers for antidepressant response and pain response, as well as identify aiTBS-induced changes in functional connectivity.
Time Frame
Pre-treatment, immediately post-treatment, 4 weeks post-treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients need to meet at least a 4/10 on a clinical pain rating scale and/or fulfill fibromyalgia diagnostic criteria on the 2010 Fibromyalgia Diagnostic Criteria (Wolfe et al., 2010) Age 18 - 70 Right-handed Agree to having fMRI scans as well as rTMS sessions Proficiency in English sufficient to complete questionnaires / follow instructions during fMRI assessments and treatment Women of childbearing potential must agree to use adequate contraception prior to study entry and continue this for the duration of the study Participants may continue antidepressant regimen, but must be stable for 6 weeks prior to enrollment in the study. Antidepressant must be of the SSRI class only (if currently on a different antidepressant, patients will be switched to an SSRI). They must maintain that same antidepressant regimen throughout the study duration. Exclusion Criteria: History of MI, CABG, CHF, or other cardiac history. Any condition that would contraindicate MRI (such as ferromagnetic metal in the body) Pregnancy or breastfeeding Any neurological condition, history of epilepsy, history of rTMS failure with FDA approved rTMS parameters, history of any implanted device or psychosurgery for depression, history of receiving ECT. OCD, narcolepsy or any additional significant neurological disorder as determined by the PI. Autism spectrum disorder Inability to stop taking medication contraindicated with treatment Any significant psychiatric disorder as identified on the Mini International Neuropsychiatric Interview and determined by the PI A positive urine toxicology screen
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Katy Stimpson, BS
Phone
650-736-2233
Email
kstimpson@stanford.edu
First Name & Middle Initial & Last Name or Official Title & Degree
James Bishop, PhD
Phone
650-736-2233
Email
jhbishop@stanford.edu
Facility Information:
Facility Name
Stanford University
City
Palo Alto
State/Province
California
ZIP/Postal Code
94304
Country
United States
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Katy Stimpson
Phone
650-736-2233
Email
kstimpson@stanford.edu
First Name & Middle Initial & Last Name & Degree
James Bishop, PhD
Phone
650-736-2233
Email
jhbishop@stanford.edu

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
24755729
Citation
Avery DH, Zarkowski P, Krashin D, Rho WK, Wajdik C, Joesch JM, Haynor DR, Buchwald D, Roy-Byrne P. Transcranial magnetic stimulation in the treatment of chronic widespread pain: a randomized controlled study. J ECT. 2015 Mar;31(1):57-66. doi: 10.1097/YCT.0000000000000125.
Results Reference
background
PubMed Identifier
25744500
Citation
Baeken C, Marinazzo D, Everaert H, Wu GR, Van Hove C, Audenaert K, Goethals I, De Vos F, Peremans K, De Raedt R. The Impact of Accelerated HF-rTMS on the Subgenual Anterior Cingulate Cortex in Refractory Unipolar Major Depression: Insights From 18FDG PET Brain Imaging. Brain Stimul. 2015 Jul-Aug;8(4):808-15. doi: 10.1016/j.brs.2015.01.415. Epub 2015 Feb 7.
Results Reference
background
PubMed Identifier
29726344
Citation
Blumberger DM, Vila-Rodriguez F, Thorpe KE, Feffer K, Noda Y, Giacobbe P, Knyahnytska Y, Kennedy SH, Lam RW, Daskalakis ZJ, Downar J. Effectiveness of theta burst versus high-frequency repetitive transcranial magnetic stimulation in patients with depression (THREE-D): a randomised non-inferiority trial. Lancet. 2018 Apr 28;391(10131):1683-1692. doi: 10.1016/S0140-6736(18)30295-2. Epub 2018 Apr 26. Erratum In: Lancet. 2018 Jun 23;391(10139):e24.
Results Reference
background
PubMed Identifier
17726913
Citation
Bonelli RM, Cummings JL. Frontal-subcortical circuitry and behavior. Dialogues Clin Neurosci. 2007;9(2):141-51. doi: 10.31887/DCNS.2007.9.2/rbonelli.
Results Reference
background
PubMed Identifier
16957531
Citation
Borckardt JJ, Nahas Z, Koola J, George MS. Estimating resting motor thresholds in transcranial magnetic stimulation research and practice: a computer simulation evaluation of best methods. J ECT. 2006 Sep;22(3):169-75. doi: 10.1097/01.yct.0000235923.52741.72.
Results Reference
background
PubMed Identifier
22918987
Citation
Cieslik EC, Zilles K, Caspers S, Roski C, Kellermann TS, Jakobs O, Langner R, Laird AR, Fox PT, Eickhoff SB. Is there "one" DLPFC in cognitive action control? Evidence for heterogeneity from co-activation-based parcellation. Cereb Cortex. 2013 Nov;23(11):2677-89. doi: 10.1093/cercor/bhs256. Epub 2012 Aug 23.
Results Reference
background
PubMed Identifier
22579164
Citation
Connolly KR, Helmer A, Cristancho MA, Cristancho P, O'Reardon JP. Effectiveness of transcranial magnetic stimulation in clinical practice post-FDA approval in the United States: results observed with the first 100 consecutive cases of depression at an academic medical center. J Clin Psychiatry. 2012 Apr;73(4):e567-73. doi: 10.4088/JCP.11m07413.
Results Reference
background
PubMed Identifier
27107779
Citation
Duprat R, Desmyter S, Rudi de R, van Heeringen K, Van den Abbeele D, Tandt H, Bakic J, Pourtois G, Dedoncker J, Vervaet M, Van Autreve S, Lemmens GM, Baeken C. Accelerated intermittent theta burst stimulation treatment in medication-resistant major depression: A fast road to remission? J Affect Disord. 2016 Aug;200:6-14. doi: 10.1016/j.jad.2016.04.015. Epub 2016 Apr 19.
Results Reference
background
PubMed Identifier
20567808
Citation
Gamboa OL, Antal A, Moliadze V, Paulus W. Simply longer is not better: reversal of theta burst after-effect with prolonged stimulation. Exp Brain Res. 2010 Jul;204(2):181-7. doi: 10.1007/s00221-010-2293-4. Epub 2010 Jun 22.
Results Reference
background
PubMed Identifier
24578040
Citation
George MS, Ketter TA, Parekh PI, Rosinsky N, Ring H, Casey BJ, Trimble MR, Horwitz B, Herscovitch P, Post RM. Regional brain activity when selecting a response despite interference: An H2 (15) O PET study of the stroop and an emotional stroop. Hum Brain Mapp. 1994;1(3):194-209. doi: 10.1002/hbm.460010305.
Results Reference
background
PubMed Identifier
20439832
Citation
George MS, Lisanby SH, Avery D, McDonald WM, Durkalski V, Pavlicova M, Anderson B, Nahas Z, Bulow P, Zarkowski P, Holtzheimer PE 3rd, Schwartz T, Sackeim HA. Daily left prefrontal transcranial magnetic stimulation therapy for major depressive disorder: a sham-controlled randomized trial. Arch Gen Psychiatry. 2010 May;67(5):507-16. doi: 10.1001/archgenpsychiatry.2010.46.
Results Reference
background
PubMed Identifier
23154644
Citation
George MS, Taylor JJ, Short EB. The expanding evidence base for rTMS treatment of depression. Curr Opin Psychiatry. 2013 Jan;26(1):13-8. doi: 10.1097/YCO.0b013e32835ab46d.
Results Reference
background
PubMed Identifier
17888408
Citation
Grimm S, Beck J, Schuepbach D, Hell D, Boesiger P, Bermpohl F, Niehaus L, Boeker H, Northoff G. Imbalance between left and right dorsolateral prefrontal cortex in major depression is linked to negative emotional judgment: an fMRI study in severe major depressive disorder. Biol Psychiatry. 2008 Feb 15;63(4):369-76. doi: 10.1016/j.biopsych.2007.05.033. Epub 2007 Sep 21.
Results Reference
background
PubMed Identifier
15664172
Citation
Huang YZ, Edwards MJ, Rounis E, Bhatia KP, Rothwell JC. Theta burst stimulation of the human motor cortex. Neuron. 2005 Jan 20;45(2):201-6. doi: 10.1016/j.neuron.2004.12.033.
Results Reference
background
PubMed Identifier
25541389
Citation
Kreuzer PM, Schecklmann M, Lehner A, Wetter TC, Poeppl TB, Rupprecht R, de Ridder D, Landgrebe M, Langguth B. The ACDC pilot trial: targeting the anterior cingulate by double cone coil rTMS for the treatment of depression. Brain Stimul. 2015 Mar-Apr;8(2):240-6. doi: 10.1016/j.brs.2014.11.014. Epub 2014 Nov 29.
Results Reference
background
PubMed Identifier
27017072
Citation
Lan MJ, Chhetry BT, Liston C, Mann JJ, Dubin M. Transcranial Magnetic Stimulation of Left Dorsolateral Prefrontal Cortex Induces Brain Morphological Changes in Regions Associated with a Treatment Resistant Major Depressive Episode: An Exploratory Analysis. Brain Stimul. 2016 Jul-Aug;9(4):577-83. doi: 10.1016/j.brs.2016.02.011. Epub 2016 Mar 2.
Results Reference
background
PubMed Identifier
25452022
Citation
Larson J, Munkacsy E. Theta-burst LTP. Brain Res. 2015 Sep 24;1621:38-50. doi: 10.1016/j.brainres.2014.10.034. Epub 2014 Oct 27.
Results Reference
background
PubMed Identifier
23159954
Citation
Lee SJ, Kim DY, Chun MH, Kim YG. The effect of repetitive transcranial magnetic stimulation on fibromyalgia: a randomized sham-controlled trial with 1-mo follow-up. Am J Phys Med Rehabil. 2012 Dec;91(12):1077-85. doi: 10.1097/PHM.0b013e3182745a04.
Results Reference
background
PubMed Identifier
17046606
Citation
Lefaucheur JP. The use of repetitive transcranial magnetic stimulation (rTMS) in chronic neuropathic pain. Neurophysiol Clin. 2006 May-Jun;36(3):117-24. doi: 10.1016/j.neucli.2006.08.002. Epub 2006 Aug 23.
Results Reference
background
PubMed Identifier
24817188
Citation
Li CT, Chen MH, Juan CH, Huang HH, Chen LF, Hsieh JC, Tu PC, Bai YM, Tsai SJ, Lee YC, Su TP. Efficacy of prefrontal theta-burst stimulation in refractory depression: a randomized sham-controlled study. Brain. 2014 Jul;137(Pt 7):2088-98. doi: 10.1093/brain/awu109. Epub 2014 May 10.
Results Reference
background
PubMed Identifier
21221011
Citation
Oberman L, Edwards D, Eldaief M, Pascual-Leone A. Safety of theta burst transcranial magnetic stimulation: a systematic review of the literature. J Clin Neurophysiol. 2011 Feb;28(1):67-74. doi: 10.1097/WNP.0b013e318205135f.
Results Reference
background
Citation
Ochsner, K. N., & Gross, J. J. (2005). Putting the ' I ' and the ' Me ' in emotion regulation : Reply to Northoff, (xx), 6613. https://doi.org/10.1016/j.tics.2005.06.005
Results Reference
background
PubMed Identifier
15315471
Citation
Ohayon MM. Specific characteristics of the pain/depression association in the general population. J Clin Psychiatry. 2004;65 Suppl 12:5-9.
Results Reference
background
PubMed Identifier
1535121
Citation
Onghena P, Van Houdenhove B. Antidepressant-induced analgesia in chronic non-malignant pain: a meta-analysis of 39 placebo-controlled studies. Pain. 1992 May;49(2):205-219. doi: 10.1016/0304-3959(92)90144-Z.
Results Reference
background
PubMed Identifier
26806627
Citation
Smolen P, Zhang Y, Byrne JH. The right time to learn: mechanisms and optimization of spaced learning. Nat Rev Neurosci. 2016 Feb;17(2):77-88. doi: 10.1038/nrn.2015.18.
Results Reference
background
PubMed Identifier
23314221
Citation
Taylor JJ, Borckardt JJ, Canterberry M, Li X, Hanlon CA, Brown TR, George MS. Naloxone-reversible modulation of pain circuitry by left prefrontal rTMS. Neuropsychopharmacology. 2013 Jun;38(7):1189-97. doi: 10.1038/npp.2013.13. Epub 2013 Jan 11.
Results Reference
background
PubMed Identifier
22444187
Citation
Taylor JJ, Borckardt JJ, George MS. Endogenous opioids mediate left dorsolateral prefrontal cortex rTMS-induced analgesia. Pain. 2012 Jun;153(6):1219-1225. doi: 10.1016/j.pain.2012.02.030. Epub 2012 Mar 22.
Results Reference
background
PubMed Identifier
28190035
Citation
Tendler A, Roth Y, Barnea-Ygael N, Zangen A. How to Use the H1 Deep Transcranial Magnetic Stimulation Coil for Conditions Other than Depression. J Vis Exp. 2017 Jan 23;(119):55100. doi: 10.3791/55100.
Results Reference
background
PubMed Identifier
23058173
Citation
Vanneste S, Ost J, Langguth B, De Ridder D. TMS by double-cone coil prefrontal stimulation for medication resistant chronic depression: a case report. Neurocase. 2014;20(1):61-8. doi: 10.1080/13554794.2012.732086. Epub 2012 Oct 11.
Results Reference
background
PubMed Identifier
29415152
Citation
Williams NR, Sudheimer KD, Bentzley BS, Pannu J, Stimpson KH, Duvio D, Cherian K, Hawkins J, Scherrer KH, Vyssoki B, DeSouza D, Raj KS, Keller J, Schatzberg AF. High-dose spaced theta-burst TMS as a rapid-acting antidepressant in highly refractory depression. Brain. 2018 Mar 1;141(3):e18. doi: 10.1093/brain/awx379. No abstract available.
Results Reference
background
PubMed Identifier
20461783
Citation
Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB, Yunus MB. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken). 2010 May;62(5):600-10. doi: 10.1002/acr.20140.
Results Reference
background

Learn more about this trial

Accelerated Theta Burst in Chronic Pain: A Biomarker Study

We'll reach out to this number within 24 hrs