rTMS for the Treatment of Chronic Pain in GW1 Veterans (rTMS)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01608321
Recruitment Status : Terminated (Did not meet recruitment goals)
First Posted : May 31, 2012
Results First Posted : April 11, 2017
Last Update Posted : April 11, 2017
Information provided by (Responsible Party):
VA Office of Research and Development

Brief Summary:
This study was designed to evaluate the effect of repetitive Transcranial Magnetic Stimulation (rTMS) in the resolution of Chronic Pain. Participants will be Veterans from the first Gulf War (GW1) who often suffer from chronic pain problems.

Condition or disease Intervention/treatment Phase
Chronic Pain Device: rTMS Device: Sham device Phase 3

Detailed Description:

A number of studies have been conducted on the health of Veterans deployed to Iraq during GW1. The focus of these studies has been primarily to define the nature of symptoms and symptom clusters and to determine if evidence supports the definition of a new unique illness. Most noteworthy is the "Iowa Study", a cross-sectional study of 3,695 Veterans from Iowa consisting of those who were and were not deployed in GW1. In telephone interviews the Gulf War deployed Veterans reported approximately twice the number of symptoms compared to those who were not deployed.

The often ambiguous and seemingly treatment resistant symptoms presented by GW1 Veterans represent a challenge to the Veteran's Affairs Health Care System on two fronts; efficacy in treatment and cost. In particular, unlike most medical conditions which can be diagnosed by objective medical findings, pain is a subjective experience (International Association for the Study of Pain, 1994). Therefore the investigators propose to engage in a clinical trial of rTMS in chronic pain that occurs in the context of multiple medical symptoms in the GW1 population. The symptom category approach will be applied with the restriction that enrolled GWI diagnosed patients will have symptoms of chronic pain as outlined in the musculoskeletal category and at least two additional symptoms.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 17 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Double-blind study of rTMS versus sham
Masking: Triple (Participant, Care Provider, Investigator)
Masking Description: rTMS sham involves using the same paddle applied to the head, the side (one shielded internally from the magnetic pulse by aluminum) turned toward the head is randomized. A small shock is also given in both circumstances to disguise the sensation produced by the active rTMS.
Primary Purpose: Treatment
Official Title: rTMS for the Treatment of Chronic Pain in GW1 Veterans
Study Start Date : September 2012
Actual Primary Completion Date : June 2015
Actual Study Completion Date : September 2015

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Chronic Pain

Arm Intervention/treatment
Experimental: rTMS
Those receiving experimental treatment will receive 20 sessions of rTMS. The treatment will be delivered by trained medical personnel.
Device: rTMS
Repetitive Transcranial Magnetic Stimulation

Placebo Comparator: Sham rTMS
Those receiving the sham rTMS will receive 20 sessions of sham rTMS. The treatment will be delivered by trained medical personnel.
Device: Sham device
Placebo Device that simulates active rTMS treatment

Primary Outcome Measures :
  1. Change in the Brief Pain Inventory (Short Form) Score [ Time Frame: Comparison of baseline BPI and end-of-treatment BPI (time 3-4 weeks) ]
    The Brief Pain Inventory (BPI) is one of the most widely used measurement tools for assessing clinical pain. The BPI allows patients to rate the severity of their pain and the degree to which their pain interferes with common dimensions of feeling and function. The basic pain scale rating is a rating of 0-10 with 0 as no pain, and 10 the worst pain imaginable.

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 70 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Born between 1936 and 1973 (ages 18 to 55 during Gulf War I) and were deployed to the Persian Gulf during Gulf War I.
  • Patients must have symptoms suggestive of Gulf War Illness, including

    • Chronic pain >= 4 on the pain severity scale of the BPI-SF at screening
    • At least 2 other symptoms in at least one of the other five (5) categories defined by the 2013 IOM report (Gulf War and Health, Treatment for Chronic Multisymptom Illness): fatigue, mood and cognition, gastrointestinal, respiratory, and neurological
  • Ability to obtain a Motor Threshold (MT) will be determined at the end of the screening process.
  • If on a psychotropic medication regimen, that regimen will be stable for at least 4 weeks prior to entry to the study and patient will be willing to remain on a stable regimen during the acute treatment phase.
  • Has an adequately stable condition and environment to enable attendance at scheduled clinic visits.
  • For female participants, agrees to use one of the following acceptable methods of birth control:

    • Complete abstinence (not having sexual intercourse with anyone)
    • An oral contraceptive (birth control pills)
    • Norplant
    • Depo-Provera
    • A condom with spermicide
    • A cervical cap with spermicide
    • A diaphragm with spermicide
    • An Intrauterine device
    • Surgical sterilization (having your tubes tied)
  • Able to read, verbalize understanding and voluntarily sign the Informed Consent Form prior to performance of any study-specific procedures or assessments.

Exclusion Criteria:

  • Pregnant or lactating female (This is a Federal Drug Administration (FDA)-required exclusion. In the future, if rTMS becomes a proven treatment for pain, its safety in the context of pregnancy should be studied separately (Nahas et al 1999)).
  • Unable to be safely withdrawn, at least two-weeks prior to treatment commencement, from medications that substantially increases the risk of having seizures.
  • Have a cardiac pacemaker.
  • Have an implanted device (deep brain stimulation) or metal in the brain.
  • Have a mass lesion, cerebral infarct or other active central nervous system (CNS) disease, including a seizure disorder.
  • Known current psychosis as determined by Diagnostic and Statistical Manual (DSM-IV) coding in chart (Axis I, psychotic disorder, schizophrenia) or a history of a non-mood psychotic disorder.
  • Diagnosis of Bipolar Affective Disorder (as determined by chart review and intake interview)
  • Current amnesic disorders, dementia, Mini Mental Status Exam (MMSE) 24 or delirium.
  • Current substance abuse (not including caffeine or nicotine) as determined by positive toxicology screen, or by medical history, within 3 months prior to screening.
  • History of loss of consciousness greater than 15 minutes due to head injury.
  • Participation in another concurrent clinical trial.
  • Patients with prior exposure to rTMS.
  • Active current suicidal intent or plan. Patient at risk for suicide will be required to establish a written safety plan involving their primary psychiatrist and the treatment team before entering the clinical trial

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01608321

United States, California
VA Palo Alto Health Care System, Palo Alto, CA
Palo Alto, California, United States, 94304-1290
Sponsors and Collaborators
VA Office of Research and Development
Principal Investigator: John W Ashford, MD PhD VA Palo Alto Health Care System, Palo Alto, CA

Responsible Party: VA Office of Research and Development Identifier: NCT01608321     History of Changes
Other Study ID Numbers: SPLD-001-11F
First Posted: May 31, 2012    Key Record Dates
Results First Posted: April 11, 2017
Last Update Posted: April 11, 2017
Last Verified: April 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Plan Description: Trial discontinued before an adequate number of subjects was tested.

Keywords provided by VA Office of Research and Development:
Chronic Pain
Gulf War Illness
Gulf War Syndrome
repetitive Transcranial Magnetic Stimulation
Transcranial Magnetic Stimulation

Additional relevant MeSH terms:
Chronic Pain
Neurologic Manifestations
Nervous System Diseases
Signs and Symptoms