Investigating Motor Cortex Processing for Pain Modulation - Full Text View

Purpose

The purpose of this study is to investigate the effects of different types of interventions (motor learning, somatosensory learning, mental imagery, observation, and tDCS) on the perception of pain and motor cortex excitability in healthy male subjects. This is an exploratory study of healthy subjects only.

Condition	Intervention	Phase
Motor Activity	Behavioral: Motor Learning with Visual Feedback Behavioral: Motor Learning without Visual Feedback Behavioral: Motor Learning -- Control Group Behavioral: Somatosensory Learning with Visual Feedback Behavioral: Somatosensory Learning without Visual Feedback Behavioral: Control Group - Sensory Task without Learning Behavioral: Control Group -- no sensory or learning task Behavioral: Observational Task Behavioral: Control Group -- Observational Task Behavioral: Mental Imagery Behavioral: Control Group - Mental Imagery Device: Transcranial Direct Current Stimulation	Phase 1

Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Double Blind (Investigator, Outcomes Assessor) Primary Purpose: Basic Science
Official Title:	Investigating Motor Cortex Processing for Pain Modulation

Resource links provided by NLM:

MedlinePlus related topics: Rehabilitation

U.S. FDA Resources

Further study details as provided by Spaulding Rehabilitation Hospital:

Primary Outcome Measures:

Change in motor cortex excitability [ Time Frame: Varies per arm -- see description ] [ Designated as safety issue: No ]
We aim to assess the effects of the intervention (ML, SL, OT, MI and tDCS) on motor cortex excitability as measured by the change in motor evoked potential (using transcranial magnetic stimulation) before and after the given intervention.
- For ML: MEP will be measured over 3 visits (approximately 1 week).
- For SL: MEP will be measured in one day only.
- For OT: MEP will be measured in one day only.
- For MI: MEP will be measured in one day only.
- For tDCS Stimulation: MEP will be measured over two visits (approximately 1 week).

Secondary Outcome Measures:

Change in mechanical pain threshold [ Time Frame: Varies per arm -- see description ] [ Designated as safety issue: No ]
We aim to assess the effects of the intervention (ML, SL, OT, MI and tDCS) on pain threshold as measured by pressure (in pounds) before and after the intervention.
- For ML: Pain threshold will be measured over 3 visits (approximately 1 week).
- For SL: Pain threshold will be measured in one day only.
- For OT: Pain threshold will be measured in one day only.
- For MI: Pain threshold will be measured in one day only.
- For tDCS Stimulation: Pain threshold will be measured over two visits (approximately 1 week).

Estimated Enrollment:	150
Study Start Date:	September 2010
Estimated Primary Completion Date:	December 2013 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: Motor Learning (ML) This arm will be conducted as a cross-over design. There will be an anticipated total of 15 subjects in this experimental arm. The subjects will undergo the three interventions listed (motor learning with visual feedback, motor learning without visual feedback, and control group) in a counterbalanced randomized order. There will be at least 24 hours between each experimental session.	Behavioral: Motor Learning with Visual Feedback This task will consist of tracing a set of symbols using the index finger of the left hand. Subjects will do this task for 20 minutes. Subjects will repeat this activity until the end of that time. The speed will be measured using a timer, and accuracy will be measured using the computer program Image Java, NIH, USA. Behavioral: Motor Learning without Visual Feedback In this group, subjects will be asked to use the index finger of their left hand to draw a square while wearing a blindfold. The task will be performed with the subject sitting and arms supported. The square will have four pins, one at each corner, to give feedback of where they need to scroll. This task will be performed for a total of 20 minutes. Behavioral: Motor Learning -- Control Group In this group, subjects will perform the following sequences of movements: Pronation and supination of the forearm Flexion and extension of wrist Abduction and adduction of fingers Open and close hand movements These tasks will be performed for 20 minutes (5 minutes for each sequence) in a single session.
Experimental: Somatosensory Learning (SL) In this arm, there will be 15 subjects per group and it will be conducted in a parallel manner. There will be an anticipated total of 60 subjects in this arm. Each subject will undergo only one of the four interventions in this arm (somatosensory learning with visual feedback, somatosensory learning without visual feedback, control group -- sensory task without learning, control group -- no sensory or learning task). The order of the interventions will be randomized.	Behavioral: Somatosensory Learning with Visual Feedback Subjects will perform a learning task involving sensory activation of the hand. The task will consist of learning letters of Braille. The subject will be able to see the braille letters as he/she learns the letters. Behavioral: Somatosensory Learning without Visual Feedback Subjects will perform a learning task involving sensory activation of the hand. The task will consist of learning letters of Braille while blindfolded. Behavioral: Control Group - Sensory Task without Learning This group will perform a task for sensory activation, without a learning task. Subjects will be instructed to put their hand on the desk with their palm facing up. During the 20 minute intervention period, the study staff will touch the subject's hand with items of different textures. Behavioral: Control Group -- no sensory or learning task This group will perform no task during the intervention period. The subject will sit quietly with their hand placed palm-up on a desk for the duration of the intervention period.
Experimental: Observational Task (OT) This experimental arm will be conducted in a parallel design. There will be 15 subjects per intervention for an anticipated total of 30 subjects in this arm. Each subject will undergo one of the two interventions in this arm (observational task, or control group). The order of the interventions will be randomized.	Behavioral: Observational Task Subjects in this group will watch a 10 second video of a right-handed person performing movements of their left index finger at a 1 Hz rate on a screen at a distance of 1 meter away. Subjects will be instructed to watch the video without any other specific instruction. Behavioral: Control Group -- Observational Task Subjects in this group will be asked to watch a video of random geometric forms for the same duration of time as those in the observational task group.
Experimental: Mental Imagery (MI) This experimental arm will be conducted in a parallel design. There will be 15 subjects per group for an estimated total of 30 subjects in this experimental arm. Each subject will undergo one of the two interventions (mental imagery or control group). The order of the interventions will be randomized.	Behavioral: Mental Imagery Subjects will be seated in a chair and will be asked to keep their arm and hand muscles fully relaxed. They will then be asked to imagine repetitive movement of the left index finger to the left thumb for 5 minutes. Subjects will then be asked to imagine sequential movement of left finger to left thumb (thumb to 2nd, 3rd, 4th, 5th) for 5 minutes. Subjects will be asked to imagine sequential and repetitive finger movements of the left hand, for a duration of 10 minutes. Behavioral: Control Group - Mental Imagery Subjects will be asked to perform simple mental math calculations for 20 minutes. (ex. adding or subtracting a one digit number from a starting number (1+1=2; 2+1=3; 3+1= 4 and so on.)
Experimental: Transcranial Direct Current Stimulation (tDCS) This experimental arm will be conducted in a cross-over design. Fifteen subjects will undergo both interventions of this arm (active tDCS and sham tDCS) in a randomized and counterbalanced order. There will be at least 3 days between each intervention to prevent carryover effects.	Device: Transcranial Direct Current Stimulation Subjects will undergo active and sham tDCS stimulation in a randomized and counterbalanced order. During both active and sham stimulation, we will use electrodes of 35cm^2, intensity of 2mA for a duration of 20 minutes. The anode electrode will be placed over the right primary motor cortex (M1) and the cathode will be placed over the contralateral supraorbital area. For active stimulation, the current will be on for the duration of 20 minutes. For sham stimulation, the current will ramp up, and then down again for 30 seconds to simulate the sensation of active tDCS. Other Name: low intensity 1x1 direct current stimulator

Eligibility

Ages Eligible for Study:	18 Years to 64 Years
Genders Eligible for Study:	Male
Accepts Healthy Volunteers:	Yes

Criteria

Inclusion Criteria

Provide informed consent to participate in the study
18 to 64 years old
No presence of rheumatologic disease as self reported
No clinically significant or unstable medical or psychiatric disorder as self reported
No history of alcohol or substance abuse within the last 6 months as self reported
No neuropsychiatric co-morbidity as self reported
No Contraindications to single pulse TMS (TMS will be used to measure cortical excitability)
- history of seizures
- unexplained loss of consciousness
- metal in the head
- frequent or severe headaches or neck pain
- implanted brain medical devices
No Contraindications to tDCS
- metal in the head
- implanted brain medical devices

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT01404039

Contacts

Contact: Felipe Fregni, MD, PhD, MPH	617-573-2326	ffregni@partners.org
Contact: Kayleen Weaver, BA	617-573-2196	kmweaver@partners.org

Locations

United States, Massachusetts
Spaulding Rehabilitation Hospital	Recruiting
Boston, Massachusetts, United States, 02114
Contact: Felipe Fregni, MD, PhD, MPH 617-573-2326 ffregni@partners.org
Contact: Kayleen Weaver, BA 617-573-2196
Principal Investigator: Felipe Fregni, MD, PhD, MPH

Sponsors and Collaborators

Spaulding Rehabilitation Hospital

Investigators

Principal Investigator:

Felipe Fregni, MD, PhD, MPH

Spaulding Rehabilitation Hospital (SRH)

More Information

No publications provided

Responsible Party:	Felipe Fregni, Principal Investigator, Spaulding Rehabilitation Hospital
ClinicalTrials.gov Identifier:	NCT01404039 History of Changes
Other Study ID Numbers:	2010-p-001256
Study First Received:	June 29, 2011
Last Updated:	April 22, 2013
Health Authority:	United States: Institutional Review Board

Keywords provided by Spaulding Rehabilitation Hospital:

learning
pain perception

ClinicalTrials.gov processed this record on May 22, 2013