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.
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.
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)
London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph's
Lead sponsor
Western University, Canada
Collaborator
St. Joseph's Health Care London
Collaborator