Transcranial Magnetic Stimulation (TMS) Effects on Pain Perception

Chronic pain represents a huge public health concern and is generally poorly understood at a
basic neurobiological level. Transcranial magnetic stimulation (TMS) is a non-invasive
technique that uses electromagnetic pulses to temporarily stimulate specific brain areas in
awake people (without the need for surgery, anesthesia, or other invasive procedures).
Previous research suggests that TMS may be effective in reducing pain perception in healthy
adults and in patients with various types of pain conditions, such as neuropathic pain.
However, there is relatively little research on TMS and pain that addresses optimal TMS
device parameters, optimal cortical targets, and potential differences in response to TMS
between healthy persons and those with chronic pain.

The purpose of this trial is to study the effects of TMS on pain perception. Specifically,
this study will determine optimal device parameters (dose) and brain targets for stimulation
with TMS in order to reduce pain in patients with neuropathic pain and in healthy adults
using laboratory pain methods.

Participants with Neuropathic Pain:

After an initial screening, eligible participants with neuropathic pain will receive a
magnetic resonance imaging (MRI) scan to help determine the best target for TMS stimulation
later in the study. Participants will be asked to record their pain experiences every day
for 2-4 weeks before receiving the first of 2 laboratory pain assessments. The laboratory
pain assessment uses a small device, controlled by a computer and attached to the underside
of the forearm, to produce different temperature stimulations. As the device reaches a
level considered painful to the participant, he/she can push a button to return to a level
of comfort.

The next part of the trial involves two, 20-minute TMS treatment sessions per day for
5-days. Participants will be randomly assigned to one of two groups. Group A will receive
real TMS and Group B will receive "sham" TMS. Study participation time for individuals with
TGN is about 8 weeks, including about 10 hours (7 visits) at the Medical University of South
Carolina (MUSC).

Healthy Volunteers:

In addition to an interview with researchers regarding medical history, healthy participants
will complete a self-report screening to assess pain history and level of depression and
anxiety. Eligible participants will be given a laboratory pain assessment, and be randomly
assigned to one of two groups: group A will receive real TMS and group B will receive
"sham" TMS. After TMS, participants will receive another full laboratory pain assessment
and complete questionnaires. For healthy volunteers, participation in the study will take
about 3 hours and may be completed in one or two visits.