Background & Aims

Musculoskeletal pain is among the most common diseases in the world, and it is the most common pain occurring after stroke. Although peripheral tissue injury may be part of the problem in chronic musculoskeletal pain, maladaptive cortical excitability and plasticity are believed to play an important role in pain maintenance and chronification after stroke. Abnormal brain oscillatory patterns and how they are impacted by disease may hold the key for symptomatic control of musculoskeletal pain.

This is a study protocol for the first exploration of cortical connectivity using transcranial magnetic stimulation (TMS) coupled to electroencephalographic (EEG) recordings in people with MSK pain.

Methods

The pilot study involves one experimental session, where 20 patients with chronic musculoskeletal disorders after stroke or transitory ischemic attack (n=10 with pain) and without pain (n=10), will be included. The main outcome is measurements of TMS-evoked EEG potentials at two different scalp sites (bilateral primary motor cortex (M1). Additionally, cortical excitability metrics (event-related spectrum perturbation, ERSP) and effective connectivity metrics (inter-trial coherence, ITC) will be extracted.

Secondary outcomes are patient reported outcome measures (quality of life -5Q5D, mood – HADS, pain – BPI and MPQ) and information about pain intensity, sleep quality and fatigue. Inclusion criteria: adults with or without pain due to musculoskeletal disorders. Exclusion criteria: Known pregnancy, current major depression, epilepsy, head metal implants.

Results

Prior pilot data show that the protocol is feasible. Data collection is planned to start February 2024.

Conclusions

Novel insights are expected to show potential changes in brain oscillations assessed by TMS-EEG in people with musculoskeletal pain.

A better understanding of individual connectivity patterns has the potential to improve the future initiatives to personalizes neuromodulation treatment with TMS. Hopefully, the knowledge gained may help improving available therapeutic treatment options for patients suffering from chronic musculoskeletal pain.

References

N/A

Presenting Author

Anne Jakobsen

Poster Authors

Anne Jakobsen

BSc PT

Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg Denmark

Lead Author

Enrico De Martino

Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg Denmark

Lead Author

Bruno Andry Couto

Institute of Science and Technology, Federal University of São Paulo, São Paulo, Brazil

Lead Author

Jakob Udby Blicher

Clinical Professor

Department of Neurology, Aalborg University Hospital

Lead Author

Thorvaldur Pálsson (PhD)

Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital

Lead Author

Thomas Graven-Nielsen

Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg Denmark

Lead Author

Daniel de Andrade

Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg Denmark

Lead Author

Topics

  • Models: Chronic Pain - Neuropathic