- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03984201
Accelerated Theta Burst in Chronic Pain: A Biomarker Study
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Katy Stimpson, BS
- Phone Number: 650-736-2233
- Email: kstimpson@stanford.edu
Study Contact Backup
- Name: James Bishop, PhD
- Phone Number: 650-736-2233
- Email: jhbishop@stanford.edu
Study Locations
-
-
California
-
Palo Alto, California, United States, 94304
- Stanford University
-
Contact:
- James Bishop, PhD
- Phone Number: 650-736-2233
- Email: jhbishop@stanford.edu
-
Contact:
- Katy Stimpson
- Phone Number: 650-736-2233
- Email: kstimpson@stanford.edu
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
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
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: iTBS over L-DLPFC to dACC
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 active or sham transcranial magnetic stimulation delivered to the L-DLPFC.
Other Names:
|
Active Comparator: iTBS over L-DLPFC to sgACC
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 active or sham transcranial magnetic stimulation delivered to the L-DLPFC.
Other Names:
|
Sham Comparator: Sham iTBS over L-DLPFC
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. |
Participants will receive active or sham transcranial magnetic stimulation delivered to the L-DLPFC.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in the Brief Pain Inventory (BPI) score
Time Frame: Pre-treatment, immediately post-treatment
|
A self-report measure designed to enable investigators to easily obtain sensitive measures of the degree of depression and individual is experiencing. Scoring:
|
Pre-treatment, immediately post-treatment
|
Change in the McGill Pain Questionnaire score
Time Frame: Pre-treatment, immediately post-treatment
|
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.
|
Pre-treatment, immediately post-treatment
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in the Montgomery Asberg Depression Rating Scale (MADRS) score
Time Frame: Pre-treatment, immediately post-treatment, 2 weeks post-treatment, 4 weeks post-treatment
|
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. |
Pre-treatment, immediately post-treatment, 2 weeks post-treatment, 4 weeks post-treatment
|
Change in teh Hamilton Rating Scale for Depression (HAM-17) score
Time Frame: Pre-treatment, immediately post-treatment, 2 weeks post-treatment, 4 weeks post-treatment
|
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.
|
Pre-treatment, immediately post-treatment, 2 weeks post-treatment, 4 weeks post-treatment
|
Change in the Pain Catastrophizing Scale (PCS) score
Time Frame: Pre-treatment, immediately post-treatment, 2 weeks post-treatment, 4 weeks post-treatment
|
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.
|
Pre-treatment, immediately post-treatment, 2 weeks post-treatment, 4 weeks post-treatment
|
Change in functional connectivity as measured by Functional Magnetic Resonance Imaging (fMRI)
Time Frame: Pre-treatment, immediately post-treatment, 4 weeks post-treatment
|
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.
|
Pre-treatment, immediately post-treatment, 4 weeks post-treatment
|
Collaborators and Investigators
Sponsor
Publications and helpful links
General Publications
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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
- Ohayon MM. Specific characteristics of the pain/depression association in the general population. J Clin Psychiatry. 2004;65 Suppl 12:5-9.
- 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.
- 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.
- 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.
- 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.
Study record dates
Study Major Dates
Study Start (Anticipated)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 48366
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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