Combining TMS and Yoga for Chronic Pain Relief in mTBI

More than half of people with mild traumatic brain injury (mTBI) also deal with Chronic Pain (CP). Treating these patients can be challenging, as their symptoms often do not respond well to regular treatments. One potential treatment is a technique called Transcranial Magnetic Stimulation (TMS), which sends magnetic pulses to the brain. A specific type of TMS called intermittent theta burst stimulation (iTBS) has been found to help reduce pain for about an hour after treatment.

#The Role of Mindfulness and Yoga

Research shows that mindfulness-based practices, such as yoga, can bring about significant improvements in both pain and quality of life for individuals with mTBI. A unique yoga program called LoveYourBrain Yoga (LYB), designed for those with TBI, has been shown to improve quality of life.

In an innovative approach, some researchers combined iTBS and yoga (iTBS+LYB) to increase treatment benefits. This combination was tested in a small pilot study with Veterans experiencing both mTBI and CP.

#Study Design and Methodology

The study followed strict guidelines approved by an ethics board, and all Participants gave informed consent. Before starting the treatment, participants met with a specialist to decide between mat or chair yoga, and they discussed their current pain management strategies. Details of the study methods are documented elsewhere.

To be part of the study, participants had to meet certain conditions. mTBI was identified using specific criteria, while chronic pain was defined as pain lasting more than six months that patients rated as moderate to severe on a pain inventory scale.

#Treatment Process

The intensity of TMS treatment was tailored to each participant based on their individual threshold for stimulation. The TMS machine used during the study guided the treatment based on MRI brain scans of each participant. The treatment targeted a specific part of the brain known to be related to pain management.

During the treatment sessions, a trained specialist provided the iTBS while another yoga instructor led a group yoga session. Each yoga session lasted 90 minutes and included breathing exercises, gentle yoga movements, guided meditation, and educational discussions.

#Participant Details and Results

A total of 19 participants signed up for the study. However, five were removed before starting because they did not meet eligibility criteria. Fourteen participants went on to receive at least one session of iTBS+LYB. Out of these, 71% completed all six sessions, while the others left due to scheduling conflicts or personal choices.

The study aimed to include 20 participants but fell just short due to practical difficulties in forming groups. Despite this, the completion rate was notably higher than previous yoga studies.

#Safety Monitoring

During the study, the researchers kept a close eye on 17 different safety indicators before and after each iTBS session. These included checking vital signs such as blood pressure and heart rate, along with monitoring any feelings of fatigue, nausea, confusion, and headaches.

A few participants did report headaches, which are a known side effect of iTBS. One participant experienced significant right-sided headaches that began a few days after the first session and were quite debilitating. While generally rare, these side effects will be monitored closely in future studies.

#Conclusion on Feasibility and Future Research

The initial findings suggest that combining iTBS with LYB yoga is both feasible and safe for treating mTBI with chronic pain. However, the small number of participants and lack of a control group are limitations that need consideration. Future studies plan to include more participants and to compare different treatment approaches, such as a group receiving fake iTBS with yoga, those getting just iTBS, and another group following standard treatment.

The results from this study provide a foundation for considering more complex treatments for mTBI and chronic pain, potentially paving the way for better management and improvement in patients' lives.