RTMS and Steroid Joint Steroid Injection in Chronic Spinal Pain

What this study is about

Chronic spinal pain (CSP) is one of the most common chronic pain conditions globally. Steroid joint injections (SJI) are a routine treatment option for patients with CLBP that is recalcitrant to other treatments. However, SJI has been shown to have limited long-term efficacy with patients often requiring another injection within months to adequately control pain. One option to prolong the analgesic effects of SJI is to use a type of noninvasive brain stimulation called repetitive transcranial magnetic stimulation (rTMS). Previous studies have shown rTMS may be capable of providing long-term pain relief in patients with chronic back pain. However, the literature on rTMS in patients with CSP is limited and no study has explored rTMS in patients receiving recurrent SJI for pain control. In this pilot randomized controlled trial study, we'll be investigating if combining rTMS with SJI in CSP individuals will enhance or prolong the analgesic effects of SJI alone. The investigators hypothesize that a combined rTMS and SJI intervention will be feasible, tolerable, and safe and will have larger and longer-lasting effects on CSP than a sham rTMS and SJI intervention.

Who can join (things the study team will check)

✅ You may be able to join if…

• Currently receiving recurrent steroid joint injections for control of chronic spinal pain at the St. Joseph's Health Centre Pain Clinic in London, Ontario, Canada,
• Have pain in the spinal region of an intensity ≥4 out of 10 in the week before your most recent steroid joint injection,
• Have received at least 2 steroid joint injections within the last 12 months at regular intervals
• Have had a consistent medication regimen for the past 3 months.

🚫 You may not be able to join if…

• Unable to read, understand, and speak English and are not able to give consent
• Known or suspected serious spinal pathology (tumour, fracture, dislocation, scoliosis)
• Spinal surgery in the past 12 months
• History of uncontrolled mental health condition(s)
• Meet any specific rTMS-related exclusion criteria listed on the safety screening questionnaire (S1; Rossi et al., 2008).

Where this trial is running

• St. Joseph's Health Care London, London, Ontario, Canada
• Parkwood Institute (Main Building), London, Ontario, Canada

Who to contact

Alexandria Roa Agudelo, MLA · 519-646-6100 · alexandria.roaagudelo@sjhc.london.on.ca

It's completely normal to call and ask questions before deciding anything. Mention the study ID: NCT05840354.