RANDOMIZED CONTROL TRIALS OF NEUROMODULCATION TO TREAT CHRONIC LOW BACK PAIN AND COMPLEX REGIONAL PAIN SYNDROME

Leader(s): Cyril Schneider
Institution(s): Université Laval
Other Members: CEGDC (Center for Excellence of Chronic Pain Management, Province of Québec), including pain centres; all Canadian pain researchers with neurostimulation and MRI



Why was the study done?
The aim of this study was twofold : to better understand brain changes in each target pain condition and, based on this new knowledge, to better adapt neurostimulation in order to normalize brain function, reduce pain and improve the function on an individual basis. Neurostimulation includes the noninvasive nonpharmacological and painless stimulation of brain and of muscles.

How was the study done?
The experiments conducted were specific to each target pain condition and included case studies as well as experimental studies (randomized double blind controlled). Measures of brain excitability and adaptation together with clinical outcomes were collected at different time-intervals before and after treatment. Treatment was neurostimulation (usually over 10 days in a row, except weekends). The protocols were adapted on an individual basis owing to brain changes (e.g., hypoactivation as compared to healthy people was normalized by excitatory stimulation of brain, hyperactivation by inhibitory stimulation).

What were the study results?
Experiments are not completed in all pain conditions. Nevertheless, stimulation of muscles (repetitive peripheral magnetic stimulation) seems to have a pivotal influence on immediate decrease of pain and brain stimulation (repetitive transcranial magnetic stimulation) a long-term influence on pain management. To this end, brain stimulation protocols had to normalize the brain maladaptive changes related to chronic pain. And this could only be done on an individualized basis given that people with the exact same condition did not present with the same brain changes. Overall, muscle stimulation had to be combined with brain stimulation for the best and longest-lasting improvements, in the four chronic pain conditions targeted.



Recent Updates:
In the process of identifying subgroups of patients with specific CRPS, fibromyalgia and cancer-related pain and conducting Non-Invasive Peripheral Stimulation and Non-Invasive Brain Stimulation and physical/occupational therapy protocols.
Last updated: May 2021


Selected Publications:

TBD