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Effect of Transmagnetic Stimulation on Conditioned Pain Modulation (CPM)

This study is currently recruiting participants.
See Contacts and Locations
Verified September 2015 by d_yarnitsky, Rambam Health Care Campus
German Research Foundation
Information provided by (Responsible Party):
d_yarnitsky, Rambam Health Care Campus Identifier:
First received: December 12, 2011
Last updated: September 16, 2015
Last verified: September 2015
While some indications of the neural circuits involved in the Conditioned Pain Modulation (CPM) process are now available, there is still need to clarify what parts of the brain are essential for this process, whether the spino-brainstem loop is largely sufficient to explain CPM or whether other cerebral and spinal regions such as frontal, somatosensory and other cortical regions contribute substantially. Whereas mere observation of correlation between these circuits while activated by brain imaging is still of considerable interest, direct experimental manipulations by repetitive transcranial magnetic stimulation (rTMS) could even establish insights into causal relationships.

Condition Intervention
Headache Migraine Device: TMS system MagPro x100, Tonica Elektronik A/S, Denmark

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: Single (Participant)
Primary Purpose: Basic Science
Official Title: The Effect of Transmagnetic Stimulation on Descending Pain Modulation

Resource links provided by NLM:

Further study details as provided by d_yarnitsky, Rambam Health Care Campus:

Primary Outcome Measures:
  • Pain scores as measured by pain numerical scale (NPS) [ Time Frame: 1 week ]
    TMS directed to pain inhibitory cortical areas will evoke pain reduction

  • Amplitude of pain-evoked potentials [ Time Frame: 1 week ]
    Change in pain evoked potentials will be assessed before and after the TMS

Secondary Outcome Measures:
  • conditioned pain modulation (CPM) [ Time Frame: 1 week ]
    Change in the efficiency of CPM will be assessed in response to TMS

Estimated Enrollment: 200
Study Start Date: December 2011
Estimated Study Completion Date: July 2016
Estimated Primary Completion Date: July 2016 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: healthy subjects
healthy subjects
Device: TMS system MagPro x100, Tonica Elektronik A/S, Denmark
repeated TMS (rTMS)
Other Name: Transcranial Magnetic Stimulator
Experimental: pain patients
Migraine and muscle headache patients
Device: TMS system MagPro x100, Tonica Elektronik A/S, Denmark
repeated TMS
Other Name: Transcranial Magnetic Stimulator

Detailed Description:
rTMS of different intensities, frequencies and location will be applied during CPM to evaluate the central mechanisms of pain modulation, their location and role in pain reduction through enhancement or suppression of activity in the relevant brain regions. In other words, cortical regions that may be implicated in CPM will be determined by augmenting or interrupting their activity via rTMSapplied to the areas under investigation. The regions will be the pain network sites, which are assumed to control the top-down influence on CPM and are superficial enough to be stimulated by the magnetic coil. These include primarily DLPFC (dorsolateral prefrontal cortex) and OFC (orbitofrontal cortex), with possible later addition of other relevant sites such as ACC (anterior cortex cinguli), insula and somatosensory cortices, etc. Since rTMS may be administered in a manner that either reduces or enhances the excitability of the stimulated cortical region, it should be possible to clarify the inhibitory or excitatory role of these regions in the CPM process. In summary, the planned studies should allow for identifying the cortical regions of the descending pain system, which are critical as starting points for the top-down modulation of CPM.

Ages Eligible for Study:   18 Years to 70 Years   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes

Inclusion Criteria:

  • age 18-70
  • males and females
  • right handed

Exclusion Criteria:

  • metal in brain/skull
  • cardiac pacemaker
  • cohlear implants
  • history of head trauma
  • history of epilepsy or seizures
  • pregnancy
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT01501045

Contact: Yelena Granovsky, PhD 502075750 ext +972

The lab of clinical neurophysiology, the faculty of medicine, Technion and Rambam Medical Center Recruiting
Haifa, Israel
Contact: Yelena Granovsky, PhD    +972 502065750      
Principal Investigator: David Yarnitsky, MD         
Sponsors and Collaborators
Rambam Health Care Campus
German Research Foundation
Principal Investigator: David Yarnitsky, professor Rambam Health Care Campus
  More Information

Responsible Party: d_yarnitsky, head of Neurology Department, Rambam Health Care Campus Identifier: NCT01501045     History of Changes
Other Study ID Numbers: TMS-001
Study First Received: December 12, 2011
Last Updated: September 16, 2015

Keywords provided by d_yarnitsky, Rambam Health Care Campus:

Additional relevant MeSH terms:
Migraine Disorders
Headache Disorders, Primary
Headache Disorders
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Neurologic Manifestations
Signs and Symptoms processed this record on August 17, 2017