Personalized accelerated TMS guided by Thompson Sampling for chronic pain
Optimizing Accelerated TMS for Chronic Pain With Thompson Sampling
This test tries a faster, personalized form of transcranial magnetic stimulation guided by a learning algorithm to see if it reduces chronic pain in adults whose pain has lasted at least a year and hasn’t improved with medications.
Quick facts
| Phase | Phase 1 |
|---|---|
| Study type | Interventional |
| Enrollment | 30 (estimated) |
| Ages | 18 Years and up |
| Sex | All |
| Sponsor | University of Minnesota Academic / other |
| Locations | 1 site (Minneapolis, Minnesota) |
| Trial ID | NCT07103135 on ClinicalTrials.gov |
What this trial studies
This Phase 1 interventional effort delivers accelerated intermittent theta burst stimulation (aiTBS) using the MagVenture X100 Pro to personalized brain targets within the somato-cognitive action network (SCAN) and the action motor network (AMN). A Bayesian reinforcement-learning method called Thompson Sampling will adaptively select stimulation sites based on each participant’s response patterns across sessions. Eligible adults have chronic pain for at least 12 months that is refractory to two medication classes and will undergo multiple short TMS sessions over a condensed timeline. Outcomes will include safety, changes in affective and sensorimotor pain measures, and network connectivity to identify responders and refine targeting.
Who should consider this trial
Good fit: Adults aged 18 or older with chronic pain for at least 12 months, average pain ≥5, stable pain medications, and prior failure of at least two classes of oral pain medications are the intended participants.
Not a fit: People with active non-nicotine/cannabis substance use disorder, lifetime bipolar or psychotic disorders, active suicidal intent, unstable medical conditions, or who cannot attend in-person visits are unlikely to benefit or be eligible.
Why it matters
Potential benefit: If successful, this approach could deliver faster, more accessible, and more effective pain relief by personalizing and accelerating brain stimulation to each person’s pain network.
How similar studies have performed: Previous TMS and theta-burst protocols for chronic pain have shown mixed but promising results, while the specific use of Thompson Sampling for adaptive site selection in pain is novel and largely untested.
Eligibility criteria
Show full inclusion / exclusion criteria
Inclusion Criteria: * Ages 18 years or older * Ability to provide written informed consent * Ability to read and to communicate verbally and in writing in English * Chronic pain persisting for at least 12 months * Pain refractory to oral pain medication (defined as failing at least two different medication classes) * Average pain intensity of ≥5 on the Numerical Rating Scale (NRS) over the past two weeks * Stable pain medication regimen for at least 4 weeks prior to enrollment * Willing and able to attend all study visits and comply with study procedures Exclusion Criteria: * Current substance use disorder (except for nicotine or cannabis) as determined by DSM-5 criteria * Active suicidal ideation with intent or plan as determined by the Columbia-Suicide Severity Rating Scale (C-SSRS) * Lifetime history of bipolar disorder, schizophrenia, or other psychotic disorder as determined by medical history * Self-reported unstable medical conditions that would pose increased risks for TMS or MRI * Pregnancy (as determined by urine pregnancy test) or planned pregnancy during the study period * Contraindications to TMS, including: * History of seizure or epilepsy * Metallic implants in the head (excluding dental fillings) * Cardiac pacemaker or other implanted medical devices * History of significant head trauma * History of intracranial surgery * Medication that significantly lowers seizure threshold that cannot be safely held * Contraindications to MRI, including: * Claustrophobia * Metallic implants or devices * Inability to lie flat for the duration of the scan * Current use of high-dose opioids (\>90 morphine milligram equivalents daily) * Participation in another clinical trial of an investigational medication or device within 30 days prior to enrollment * Any condition that, in the investigator\'s opinion, would make it unsafe or difficult for the participant to complete the study
Where this trial is running
Minneapolis, Minnesota
- University of Minnesota — Minneapolis, Minnesota, United States (Recruiting)
Study contacts
- Principal investigator: Alexander B Herman, MD, PhD — University of Minnesota
- Study coordinator: Matthew Maple
- Email: maple036@umn.edu
- Phone: 612-946-1424
How to participate
- Review the eligibility criteria above with your treating physician.
- Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
- Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.