Repetitive Transcranial Magnetic Stimulation Therapy in Spinal Cord Injury Related Neuropathic Pain

Spinal cord injury is a disability that causes the loss of many functions for example motor,sensory and autonomic functions in the body. Neuropathic pain is a common problem in participants with spinal cord injury. Many treatment options have been offered for a debilitating condition that has major negative effects on participant's quality of life but provides limited effects and many secondary effects. There is evidence for neuromodulation techniques to improve many pain conditions, such as neuropathic pain. One innovative method for neuropathic pain management, rTMS, is a non-invasive neuromodulation intervention with a low risk of side effects that works by altering brain activity. While most studies to date have mainly targeted the primary motor cortex (M1), fewer studies have reported analgesic effects after stimulation of other cortical areas such as the dorsolateral prefrontal cortex (DLPFC).

The initial assessment will include answering questionnaires: Brief Pain Inventory, Neuropathic Pain Symptom Inventory(NPSI), International Spinal Cord Injury Pain Basic Data Set (ISCIPBDS) self-report version, Patient Catastrophizing Scale(PCS), Beck Depression Inventory,Quality of Life Index Spinal Cord Injury v3 (QLI-SCI), Pain Catastrophizing Scale (PCS),Pittsburgh Sleep Quality Index and previous medication and treatment questionnaires.Participants will be asked to complete the above-mentioned questionnaires post-rTMS treatment and at 2 months after their last rTMS treatment.

TMS Protocol: Participants will undergo high frequency rTMS sessions 5 days a week for 4 weeks (20 treatments total). Daily rTMS sessions will include at a frequency of 10 Hz, treatment intensity will be applied at 120% of the participants resting motor threshold (RMT). A RMT is the minimal intensity required to evoke a motor evoked potential and will be obtained by administering single-pulse TMS to the left motor cortex participant a will be seated in a comfortable chair or their wheelchair for each rTMS session.

Participants with spinal cord injury receiving rTMS in DLPFC or M1 protocol in addition to neurological rehabilitation will be compared with the sham rTMS group in terms of neuropathic pain, sleep quality, depression and quality of life.

• Change from baseline International Spinal Cord Injury Pain Basic Data Set (ISCIPBDS) self-report version at 1. and 2 months. [Срок оценки: To be assessed at baseline, after rTMS treatment (1-month) and 2-months after rTMS treatment.]
• Change from baseline Quality of Life Index Spinal Cord Injury version (QLI-SCI) at 1. and 2 months. [Срок оценки: To be assessed at baseline, after rTMS treatment (1-month) and 2-months after rTMS treatment.]
• Change from baseline Pain Catastrophizing Scale (PCS) at 1. and 2 months. [Срок оценки: To be assessed at baseline, after rTMS treatment (1-month) and 2-months after rTMS treatment.]
• Change from baseline Beck Depression Inventory (BDI) Scores at 1. and 2 months. [Срок оценки: To be assessed at baseline, after rTMS treatment (1-month) and 2-months after rTMS treatment.]
• Change in the Patient's Global Impression of Change (PGIC) observed at 1 month and 2 months. [Срок оценки: To be assessed after rTMS treatment (1-month) and 2-months after rTMS treatment.]
• Change from baseline Neuropathic Pain Symptom Inventory (NPSI) at 1.and 2 months. [Срок оценки: To be assessed at baseline, after rTMS treatment (1-month) and 2-months after rTMS treatment.]
• Change from baseline Pittsburgh Sleep Quality Index (PSQI) at 1. and 2 months. [Срок оценки: To be assessed at baseline, after rTMS treatment (1-month) and 2-months after rTMS treatment.]
• Change from baseline Modified Ashworth Scale (MAS) at 1. and 2 months. [Срок оценки: To be assessed at baseline, after rTMS treatment (1-month) and 2-months after rTMS treatment.]