MUSC researchers want to know if brain stimulation can treat chronic pain without medication
Almost every day for two weeks, Kyle Skidmore put on a swim cap and allowed a technician to use a magnetic coil to stimulate parts of his brain.
Julia Imperatore, a research specialist, had marked the swim cap so she could tailor the stimulation for Skidmore each of the 13 times he came to the Medical University of South Carolina. He agreed to take part in a clinical trial that aims to prove that this technology, called “transcranial magnetic stimulation” or “TMS,” can relieve ongoing pain.
TMS is already used to treat depression and migraines. Studies also have shown it can be helpful in reducing chronic pain, but so far those studies have not been sufficient to win approval from the Food and Drug Administration. The research comes at a time when specialists search for answers to an epidemic of painkiller addiction sweeping the country.
Skidmore said at least for him, TMS seems to have worked. He said he agreed to participate in the trial because he has been “searching for something that’s going to give me my life back, so my days aren’t consumed with pain.” He said if TMS is approved for chronic pain, he would definitely seek it out.
The side effects of TMS, which was developed in Charleston, are minimal and often include headaches. Dr. Colleen Hanlon, who is leading the research at MUSC, said the underlying problem is that there are very few options available to treat chronic pain that are as powerful as opioids.
“We’re trying to give another tool to use to treat chronic pain,” Hanlon said.
MUSC is recruiting all adults younger than 65 who rely on an opioid painkiller prescription for the clinical trial.
Traditional opioid painkillers work by binding to opiate receptors in the brain. TMS can achieve the same thing, Hanlon said, by mimicking that effect. Magnetic fields deliver a pulse to the brain, which Skidmore said feels strange but is not particularly painful.
A key difference between opioids and TMS: In order for opioids to continue to be effective, a patient needs more and more. That does not appear to be the case with TMS, Hanlon said. People don’t develop a tolerance to it.
In a previous study, she said MUSC researchers found TMS could relieve chronic pain for a couple of hours when given just one time. Now, they want to show it can give more sustained relief if it is administered over the course of weeks.
Skidmore, who has had chronic back pain since 2007, has tried all kinds of treatments. A surgery went totally wrong. He knows opioid painkillers have done him little good. But it’s hard to avoid those prescriptions.
“All they want to do is to get off medication,” Imperatore said. “But they’re in so much pain. It’s not possible.”
The risk is all too real. Dr. Allen Jackson, an addiction doctor at the Center for Behavioral Health in North Charleston, prescribes methadone, a clinically approved treatment drug. He said most of the cases of addiction he sees begin with prescription pills. But an addiction to prescriptions can easily turn into a heroin dependency.
“People who are addicted are going to turn to what’s available,” Jackson said.
Though South Carolina has avoided the brunt of heroin and fentanyl overdoses hammering states such as West Virginia and Ohio, the state still over-prescribes the dangerous painkillers. A 2012 study by the Centers for Disease Control and Prevention found there were more opioid prescriptions written in 2012 in South Carolina than there are people in the state.
The Center for Behavioral Health has more than 400 patients, Jackson said. But treatment can be expensive and difficult to convince insurance companies to cover, so it remains out of reach for many, he said.
The MUSC researchers’ focus is to address the root of the problem and find alternatives to pain treatment. Hanlon said people with an opioid use disorder are not the focus of the study, but rather those who have been on opioids for a while and haven’t gotten better.
Hanlon said there are already dozens of studies showing TMS can treat pain. To win FDA approval, she said her team wants to earn funding for a larger, year-long trial across multiple locations next. She said she is optimistic given how positive the data has been so far.
“We’re not shooting in the dark,” she said. “There’s a clear pathway that’s led to this point.”