Accelerated repetitive transcranial magnetic stimulation for chronic musculoskeletal pain control: a crossover parallel group study protocol
DOI:
https://doi.org/10.17267/2965-3738bis.2025.e5994Keywords:
Transcranial Magnetic Stimulation, Theta Burst Stimulation, Chronic PainAbstract
BACKGROUND: Chronic musculoskeletal pain is a prevalent condition associated with significant disability and high healthcare costs. Repetitive Transcranial Magnetic Stimulation (rTMS) has shown promise in pain management, but traditional protocols require daily sessions, posing logistical challenges. Accelerated Theta Burst Stimulation (TBS) offers a more practical alternative by delivering multiple stimulations in a single day. However, its use in chronic pain has not been investigated. OBJECTIVE: This study aims to evaluate the efficacy and safety of an accelerated TBS protocol in reducing pain in individuals with chronic musculoskeletal pain. It also explores neurophysiological mechanisms underlying treatment effects using electroencephalography (EEG). METHODS: A randomized, double-blind, two-phase crossover trial will be conducted with 25 chronic musculoskeletal pain adults. Participants will undergo both active and sham TBS protocols with a minimum one-week washout between phases. Each active session will consist of four 3-minute stimulations targeting the dorsolateral prefrontal cortex (DLPFC) with 600 pulses per session. The primary outcome is pain reduction, and secondary outcomes include changes in EEG oscillations and pressure pain thresholds. Safety will be monitored through reports of adverse effects. RESULTS: This protocol aims to generate preliminary evidence on the feasibility and efficacy of accelerated TBS for chronic musculoskeletal pain. It is expected that active TBS will result in significant pain reduction and modulation of EEG activity, including increased alpha power and reduced theta activity post-treatment. CONCLUSION: This study represents a novel application of accelerated TBS in chronic musculoskeletal pain management. The findings will also contribute to understanding the neuroplastic mechanisms involved in pain modulation through non-invasive brain stimulation.
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Copyright (c) 2025 Rafael Jardim Duarte-Moreira, Francisco Xavier de Brito, Graziela Mota Silva, Poliana Victória Carmo de Alcântara, Janine Ribeiro Camatti, Tiago da Silva Lopes, Yossi Zana, Cleber Luz-Santos, José Garcia Vivas Miranda, Abrahão Fontes Baptista
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This work is licensed under a Creative Commons Attribution 4.0 International License.
