Repetitive Transcranial Magnetic Stimulation in Cancer Pain Management

Feasibility and Effectiveness of Repetitive Transcranial Magnetic Stimulation in Patients With Cancer Pain

Over half of cancer patients experience cancer-related pain. Despite advances in pain management with opioids, many patients continue to suffer from chronic cancer pain. The underlying mechanisms of cancer-related pain remain poorly understood, but they may be linked to brain neuroplasticity. As a result, some researchers suggest that targeting the motor cortex in cancer patients could improve pain management. However, few studies have investigated the effectiveness of remodeling neuroplasticity with repetitive transcranial magnetic stimulation (rTMS) to reduce cancer-related pain. To validate the use of rTMS in cancer-related pain, we plan to conduct a randomized controlled trial involving 30 cancer pain patients. Participants will be randomly assigned to receive either rTMS or sham rTMS treatment. Functional magnetic resonance imaging (fMRI) and pain index assessments will be conducted before and after the treatment to evaluate the outcomes.

Study Overview

• Status: Not yet recruiting
• Conditions: Pain; Cancer
• Intervention / Treatment: Device: Repetitive transcranial magnetic stimulation (rTMS)

• Study Type: Interventional
• Enrollment (Estimated): 30
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Chien-Hung Lai, MD, PhD; Phone Number: 3242 +886227372181; Email: chlai@tmu.edu.tw

Study Locations

• Taiwan
  • Taipei, Taiwan, 110
    • Taipei Medical University Hospital
    • Contact: Chien-Hung Lai; Phone Number: 3242 0227372181; Email: chlai@tmu.edu.tw

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Patients have cancer pain symptoms, confirmed by a physician as cancer pain or neuropathic cancer pain
2. Experienced the worst pain NRS score ≥ 4
3. The patient demonstrate good cognition and is able to cooperate with the assessment of pain severity.
4. The estimated survival time exceeds 3 months.
5. Pre-existing bisphosphonate, chemotherapy, and hormonal therapy regimens remained unchanged throughout the study.

Exclusion Criteria:

1. Individuals who have undergone head surgery or have metal implants in the head.
2. Individuals with implanted cardiac pacemakers or cochlear prostheses.
3. Have a history of epilepsy.
4. Patients diagnosed with primary brain tumors or metastatic brain lesions.
5. Present with additional neurological, psychiatric, or severe medical disorders.
6. Individuals with metallic implants located in the cranial or cervical regions.
7. Women who are pregnant.
8. Presence of acute pain in any body region attributable to other medical conditions. -

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Repetitive transcranial magnetic stimulation	Device: Repetitive transcranial magnetic stimulation (rTMS); Repetitive transcranial magnetic stimulation toward for cancer pain (real and sham control)
Sham Comparator: Sham Repetitive transcranial magnetic stimulation	Device: Repetitive transcranial magnetic stimulation (rTMS); Repetitive transcranial magnetic stimulation toward for cancer pain (real and sham control)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Brief Pain Inventory, BPI	BPI is to assess the severity of pain and the impact of pain on daily functions, including Severity of pain, impact of pain on daily function, location of pain, pain medications and amount of pain relief in the past 24 hours.	Assess the BPI outcome before the intervention, after 1 week and 2 weeks of intervention, as well as 1 week and 4 weeks after the intervention is completed.
McGill Pain Questionnaire	The McGill Pain Questionnaire (MPQ) is a self-report measure used by patients with various diagnoses to assess pain. It consists of 78 words, from which respondents select those that best describe their pain experience. The words are categorized as follows: Dimensions 1 to 10 (pain descriptors): 3 words Dimensions 11 to 15 (affective components of pain): 3 words Dimension 16 (evaluation of pain): 1 word Dimensions 17 to 20 (miscellaneous): 1 word. Scores are calculated by summing the values associated with each selected word, with scores ranging from 0 (no pain) to 78 (severe pain). Qualitative differences in pain are reflected in the respondent's word choices.	Assess MPQ scores before the intervention, after 1 week and 2 weeks of intervention, as well as 1 week and 4 weeks after the intervention is completed.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Numerical Rating Scale, NRS	The Numeric Rating Scale (NRS) is commonly used to measure pain intensity and is well validated. It is scored from 0 to 10, with 0 representing no pain and 10 representing the worst pain imaginable	Assess the NRS scale before the intervention, after 1 week and 2 weeks of intervention, as well as 1 week and 4 weeks after the intervention is completed.
Visual Analogue Scale , VAS	The Visual Analog Scale (VAS) is a validated, subjective measure of both acute and chronic pain. Scores are recorded by making a handwritten mark on a 10-cm line that represents a continuum from 'no pain' to 'worst pain.'	Assess the VAS scale before the intervention, after 1 week and 2 weeks of intervention, as well as 1 week and 4 weeks after the intervention is completed.
Resting-state functional imaging, rsfMRI	In fMRI, by adding each pixel, the time course of a pixel is related to the average time course of the corresponding region of interest (ROI). In this context, the cross-correlation coefficient map for each seed ROI will be generated. This cross-correlation coefficient map will then undergo Fisher's z-transformation to approximate a normal distribution.	Assess the fMRI results before the intervention and after 2 weeks of interventions.
Beck Depression Inventory, BDI	BDI is a 21-item, self-report rating inventory that measures characteristic attitudes and symptoms of depression. Each answer is being scored on a scale value of 0 to 3. Higher total scores indicate more severe depressive symptoms.	Assess the BDI scale before the intervention, after 1 week and 2 weeks of intervention, as well as 1 week and 4 weeks after the intervention is completed.
The 36-Item Short Form Survey quality of life	The 36-Item Short Form Survey (It comprises 36 questions that cover eight domains of health) is an outcome measure instrument that is often used, well-researched, self-reported measure of health. It comprises 36 questions that cover eight domains of health.	Assess the The SF-36 outcome before the intervention, after 1 week and 2 weeks of intervention, as well as 1 week and 4 weeks after the intervention is completed.

Collaborators and Investigators

• Sponsor: Taipei Medical University Hospital

Study record dates

Study Major Dates

• Study Start (Estimated): May 20, 2025
• Primary Completion (Estimated): December 16, 2026
• Study Completion (Estimated): December 30, 2026

Study Registration Dates

• First Submitted: April 22, 2025
• First Submitted That Met QC Criteria: April 22, 2025
• First Posted (Actual): April 29, 2025

Study Record Updates

• Last Update Posted (Actual): May 18, 2025
• Last Update Submitted That Met QC Criteria: May 14, 2025
• Last Verified: March 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Cancer Pain
• Other Study ID Numbers: N202209046

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No