Brain as a Therapeutic and Research Target in Trigeminal Neuropathic Pain

NCT ID: NCT03003715

Last Updated: 2017-11-24

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

13 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-09-30

Study Completion Date

2012-12-31

Brief Summary

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The main goal of this study to integrate techniques producing images of the brain (also called neuroimaging techniques) with non-invasive brain stimulation to investigate factors that may be associated with chronic pain in patients with Trigeminal Neuropathic Pain (TNP).

Detailed Description

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Trigeminal neuropathic pain (TNP) disorders, such as classical trigeminal and post-surgical neuralgia, are debilitating chronic conditions with pain that is either spontaneous or that can be intensely evoked by light touch to the facial skin. Although neuroimaging techniques have provided insights into some brain mechanisms of experimental trigeminal pain in humans (DaSilva et al., 2002; Borsook et al., 2003), it is not well understood how structural and molecular mechanisms are affected during the course of TNP, and how they can be safely modulated for therapeutic and research purposes. Understanding these processes is crucial to determine the structures engaged in the development and persistence of TNP.

We will test the hypothesis that chronicity of TNP is sustained by changes at cellular and molecular levels in neural circuits associated with pain perception and modulation, rather than by the initial peripheral etiology, and that this dysfunction can be safely targeted and modulated as a therapeutic approach by transcranial direct current stimulation (tDCS). To achieve this goal we will use a neuroimaging technique, PET, employing a mathematical model that permits the quantification of opioid receptor availability in vivo.

Conditions

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Trigeminal Neuropathic Pain

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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Refractory Trigeminal Neurpathic Pain (TNP) Patients

All patients receive QST prior to PET scan used to obtain baseline measures, then placebo tDCS, followed by QST and Active tDCS, over the course of a 90 minute PET scan; QST is used again to take final measurements 30 minutes later.

Group Type EXPERIMENTAL

PET Scans

Intervention Type PROCEDURE

Two 90 minute scans whose maximum radiological dose is 15 mCi \[11 C\] carfentanil, a selective and specific mu-opioid receptor radioligand. The first one provided baseline data, and the second occurred with the sequence of sham tDCS and tDCS as described in each arm description.

transcranial direct current stimulation (tDCS)

Intervention Type PROCEDURE

In active tDCS, a 2 milli-amp transcranial direct current stimulation is for 20 minutes.

MRI

Intervention Type PROCEDURE

No radiotracer is used; 3 tesla scanner; all participants have MRI prior to PET scans.

sham tDCS (prior to real tDCS)

Intervention Type OTHER

For sham tDCS, current is applied only for 30 seconds, as sensations arising from tDCS treatment occur only at the beginning of application; however the equipment will be on the participant for 20 minutes to match that of the active tDCS application.

Healthy volunteers

All volunteers receive QST prior to PET scan used to obtain baseline measures, then placebo tDCS, followed by QST and Active tDCS, over the course of a 90 minute PET scan; QST is used again to take final measurements 30 minutes later.

Group Type EXPERIMENTAL

PET Scans

Intervention Type PROCEDURE

Two 90 minute scans whose maximum radiological dose is 15 mCi \[11 C\] carfentanil, a selective and specific mu-opioid receptor radioligand. The first one provided baseline data, and the second occurred with the sequence of sham tDCS and tDCS as described in each arm description.

transcranial direct current stimulation (tDCS)

Intervention Type PROCEDURE

In active tDCS, a 2 milli-amp transcranial direct current stimulation is for 20 minutes.

MRI

Intervention Type PROCEDURE

No radiotracer is used; 3 tesla scanner; all participants have MRI prior to PET scans.

sham tDCS (prior to real tDCS)

Intervention Type OTHER

For sham tDCS, current is applied only for 30 seconds, as sensations arising from tDCS treatment occur only at the beginning of application; however the equipment will be on the participant for 20 minutes to match that of the active tDCS application.

Interventions

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PET Scans

Two 90 minute scans whose maximum radiological dose is 15 mCi \[11 C\] carfentanil, a selective and specific mu-opioid receptor radioligand. The first one provided baseline data, and the second occurred with the sequence of sham tDCS and tDCS as described in each arm description.

Intervention Type PROCEDURE

transcranial direct current stimulation (tDCS)

In active tDCS, a 2 milli-amp transcranial direct current stimulation is for 20 minutes.

Intervention Type PROCEDURE

MRI

No radiotracer is used; 3 tesla scanner; all participants have MRI prior to PET scans.

Intervention Type PROCEDURE

sham tDCS (prior to real tDCS)

For sham tDCS, current is applied only for 30 seconds, as sensations arising from tDCS treatment occur only at the beginning of application; however the equipment will be on the participant for 20 minutes to match that of the active tDCS application.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Daily chronic TNP for at least 6 months not adequately controlled by pervious medicine therapies;
* minimal average baseline pain score of 4 (moderate to severe) in the visual analogue scale (VAS);
* unilateral pain
* orofacial allodynic region to mechanical (light touch or palpation) or thermal stimulation (head or cold);

Exclusion Criteria

* pregnancy or planning to become pregnant
* local pathology (e.g. orofacial lesion)
* history of systemic disorders (e.g. MS)
* history of other chronic pain disorder (e.g. back pain)
* recent orofacial surgery or trauma (\< 6 months)
* history of central origin disorders (e.g. stroke)
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University of Michigan

OTHER

Sponsor Role lead

Responsible Party

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Alexandre DaSilva, DDS, MS

DDS, D.Med.Sc.

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Alexandre F DaSilva, DMedSci

Role: PRINCIPAL_INVESTIGATOR

University of Michigan

Locations

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University of Michigan

Ann Arbor, Michigan, United States

Site Status

Countries

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United States

Other Identifiers

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HUM00024607

Identifier Type: -

Identifier Source: org_study_id