Effect of Transmagnetic Stimulation on Conditioned Pain Modulation (CPM)

Study Overview
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Brief Summary
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While some indications of the neural circuits involved in the Conditioned Pain Modulation (CPM) process are now available, there is still need to clarify what parts of the brain are essential for this process, whether the spino-brainstem loop is largely sufficient to explain CPM or whether other cerebral and spinal regions such as frontal, somatosensory and other cortical regions contribute substantially. Whereas mere observation of correlation between these circuits while activated by brain imaging is still of considerable interest, direct experimental manipulations by repetitive transcranial magnetic stimulation (rTMS) could even establish insights into causal relationships.

Detailed Description
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rTMS of different intensities, frequencies and location will be applied during CPM to evaluate the central mechanisms of pain modulation, their location and role in pain reduction through enhancement or suppression of activity in the relevant brain regions. In other words, cortical regions that may be implicated in CPM will be determined by augmenting or interrupting their activity via rTMSapplied to the areas under investigation. The regions will be the pain network sites, which are assumed to control the top-down influence on CPM and are superficial enough to be stimulated by the magnetic coil. These include primarily DLPFC (dorsolateral prefrontal cortex) and OFC (orbitofrontal cortex), with possible later addition of other relevant sites such as ACC (anterior cortex cinguli), insula and somatosensory cortices, etc. Since rTMS may be administered in a manner that either reduces or enhances the excitability of the stimulated cortical region, it should be possible to clarify the inhibitory or excitatory role of these regions in the CPM process. In summary, the planned studies should allow for identifying the cortical regions of the descending pain system, which are critical as starting points for the top-down modulation of CPM.

Official Title
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The Effect of Transmagnetic Stimulation on Descending Pain Modulation

Conditions
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Headache, Migraine

Intervention / Treatment
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* Device: TMS system MagPro x100, Tonica Elektronik A/S, Denmark
* Device: TMS system MagPro x100, Tonica Elektronik A/S, Denmark


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: age 18-70 males and females right handed Exclusion Criteria: metal in brain/skull cardiac pacemaker cohlear implants history of head trauma history of epilepsy or seizures pregnancy

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: healthy subjects<br>healthy subjects | Device: TMS system MagPro x100, Tonica Elektronik A/S, Denmark<br>* repeated TMS (rTMS)<br>* Other names: Transcranial Magnetic Stimulator;|
| Experimental: pain patients<br>Migraine and muscle headache patients | Device: TMS system MagPro x100, Tonica Elektronik A/S, Denmark<br>* repeated TMS<br>* Other names: Transcranial Magnetic Stimulator;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain scores as measured by pain numerical scale (NPS) | TMS directed to pain inhibitory cortical areas will evoke pain reduction | 1 week | 
| Amplitude of pain-evoked potentials | Change in pain evoked potentials will be assessed before and after the TMS | 1 week | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| conditioned pain modulation (CPM) | Change in the efficiency of CPM will be assessed in response to TMS | 1 week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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TMS, CPM, headache, migraine, EEG, psychophysics