- A five-day brain stimulation treatment has shown promise in preventing future pain.
- Chronic pain affects over 1.5 billion people worldwide and costs the Australian economy an estimated $139 billion annually due to lost productivity and healthcare expenses.
- Current treatments are ineffective and can only be applied after pain is becomes a chronic issue (i.e. pain that lasts for three months or longer).
- Researchers at NeuRA have discovered that a new approach involving brain stimulation to target brain activity associated with chronic pain susceptibility before pain begins, potentially preventing the transition to chronic pain.
Chronic pain is a significant global health challenge, affecting nearly 20 per cent of the world’s population. Researchers from NeuRA and UNSW have discovered a preventative brain stimulation technique that could stop chronic pain before it takes hold, offering new hope for millions who live with this debilitating condition.
NeuRA Research Fellow and Head of Neurostimulation at the NeuroRecovery Research Hub at UNSW, Dr Nahian Chowdhury, led the research that found a five-day course of repetitive transcranial magnetic stimulation (rTMS) before pain onset could significantly reduce future pain intensity and improve brain activity associated with pain resilience. rTMS is a non-invasive procedure where magnetic pulses are delivered through a coil worn on the scalp to stimulate specific brain regions.
“Our research showed that repetitive transcranial magnetic stimulation, or rTMS, which is a non-invasive brain stimulation, could be delivered in a preventative way, before pain takes hold,” Dr Chowdhury said.
“Chronic pain is a global health issue, impacting patient quality of life and healthcare systems. We looked at how we can support the body before a pain event, and before pain is chronic, by targeting the features of cortical activity associated with chronic pain susceptibility.
“We found that a five-day course of rTMS before pain onset has the potential to interrupt the transition to chronic pain.”
Pre-empting pain before it strikes
The research involved 41 healthy participants in a blinded, randomised, sham-controlled trial over 26 days. Participants attended five sessions, where they received either active or sham rTMS. Key brain activity measures such as Peak Alpha Frequency (PAF) and corticomotor excitability (CME) were assessed on days zero and four. At the end of day four, participants received an injection into their cheek to induce prolonged pain. For days 5 – 25, the trial participants completed twice-daily electronic diaries measuring pain and function.
“For this trial, we had to induce pain in the participants, which we did through an injection in their right cheek,” Dr Chowdhury said.
“We were looking to see what the experience was for participants who had received the rTMS, versus what happened for those who had received the sham. Those people who had received active rTMS experienced lower pain on chewing and yawning than those who received the sham.”
However, Dr Chowdhury said those who had received rTMS found it didn’t alter the severity or time course of pain associated with swallowing. Whilst active rTMS inceased PAF speed, it didn’t alter CME.
“Regardless of whether people received the active treatment or sham, our analysis showed that those with faster PAF and higher CME on Day 4 had lower intensity future pain,” Dr Chowdhury said, suggesting that brain activity metrics in future be used to predict pain resilience.
Promise for new chronic pain intervention
While more research is needed, these findings open the door for preventative treatments for those at high risk of developing chronic pain, such as patients preparing for surgery.
“Whilst chronic pain is a significant problem, the current interventions are usually only applied once the pain is chronic,” Dr Chowdhury said.
“More research is required, but this research shows in some situations – such as for people undergoing a surgery known to be painful or often leading to chronic pain – there is promise from preventative treatments that may be able to stop chronic pain before it begins.”
Dr Chowdhury’s research was published in PAIN and can be read here: https://journals.lww.com/pain/fulltext/9900/a_5_day_course_of_repetitive_transcranial_magnetic.779.aspx#related
