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NCT Number: NCT06129890

Neuromodulation in Patients With Neuropathic Pain and Depression.

High-frequency repetitive transcranial magnetic stimulation of the primary motor cortex has shown its effect on refractory neuropathic pain, and rTMS of the dorsolateral prefrontal cortex is commonly used for treatment-resistant depression.

The treatment for patients suffering from neuropathic pain and depression, concomitantly, still needs to be studied, as there are some specificities in both symptoms and brain functional MRI.

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Key information

Age range

18 year–85 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

CHU de Saint-Etienne

Saint-Etienne, 42055, France

Location status: Recruiting

Location contact

Christelle CREACH, MD

SUB_INVESTIGATOR

Roland PEYRON, PhD

CONTACT

[email protected]

(0)4 77 12 78 05 ext. +33

Roland PEYRON, PhD

PRINCIPAL_INVESTIGATOR

About this study

This project is a cross-over study for these patients, including 4 sessions of either M1 or DLPFC rTMS, a wash-out period, followed by 4 sessions of the other stimulation site, to assess the efficiency of a DLPFC rTMS for neuropathic pain with a comorbid depression. Besides pain intensity and quality, patient's mood, quality of life, and catastrophizing will be assessed.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Central or peripheral neuropathic pain
  • Chronic pain (present for more than 6 months) with intensity greater than or equal to 4/10 on the numerical scale
  • Pain present on a daily or near-daily basis (at least 4 days a week)
  • Patient not completely relieved by recommended drug treatments for first- and second-line neuropathic pain
  • Stable analgesic treatment (no new treatment or dosage adjustment) for at least one month, and will not need to be modified for the duration of the study.
  • Patient with a depressive episode characterized according to DSM V criteria
  • Indication for motor cortex rTMS by a neurologist
  • Patient can be followed for the entire duration of the study
  • Patient having received informed consent to participate in the study, and having co-signed a consent form with the investigator
  • Member or beneficiary of a social security scheme

Exclusion criteria

  • Industrial accident or litigation
  • Contraindication to rTMS or MRI (seismotherapy treatment since the previous month; epilepsy and/or history of epilepsy; history of head trauma; neurosurgical lesion; intracranial hypertension; intracerebral metal clip; piercing; pacemaker; insulin pump; metal prosthesis; pregnant or breast-feeding woman; claustrophobia)
  • Drug or psychoactive substance abuse
  • Neuropathic pain in the context of a progressive pathology (HIV, cancer, systemic disease disease)
  • Presence of other pain more severe than that justifying inclusion
  • Patient unable to understand informed consent
  • Patient unwilling or unable to stop treatments prohibited during the study
  • Patient participating in another research protocol involving a drug within the 30 days prior to inclusion
  • Patient deprived of liberty or under legal protection (guardianship, curatorship, safeguard of justice safeguard, family safeguard)
  • Minor patient

Treatment and study plan

Repetitive transcranial magnetic stimulation (rTMS) - M1/DLPFC

Device

Repetitive transcranial magnetic stimulation (rTMS) is a treatment technique involving the induction of an electrical current on the surface of the cortex by applying a magnetic field to the scalp. This field is generated using a stimulation loop controlled by a robotic arm linked to a neuronavigation system. rTMS of M1 then rTMS of DLPFC.

Other names: rTMS

Repetitive transcranial magnetic stimulation (rTMS) - DLPFC/M1

Device

Repetitive transcranial magnetic stimulation (rTMS) is a treatment technique involving the induction of an electrical current on the surface of the cortex by applying a magnetic field to the scalp. This field is generated using a stimulation loop controlled by a robotic arm linked to a neuronavigation system. rTMS of DLPFC then rTMS of M1.

Other names: rTMS

Primary outcomes

  1. Comparison of pain relief rates between the two stimulation targets (M1 and DLPFC)

    Time frame: 2 weeks after the last rTMS session for each arm

    Patients are asked how much pain relief they have experienced since the last session.

Secondary outcomes

  1. Neuropathic dimension

    Time frame: Up to 26 weeks

    Neuropathic dimension: overall score of the Neuropathic Pain Symptoms Inventory (NPSI) questionnaire and its dominant sub-score. The dominant being defined as the score of the dimension (e.g. allodynia, burning, dysesthesia) most painful at the inclusion visit (S0).This questionnaire is used to assess the presence and evolution of neuropathic pain symptoms, as well as the effectiveness of specific neuropathic pain treatments. Based on questioning, it comprises 12 questions (10 descriptive of symptoms and and 2 to assess pain frequency and duration).

    Score is from 0 ((no pain) to 120 (maximun pain)

  2. Pain evolution

    Time frame: Up to 26 weeks

    Pain evolution via multiple Visual Analogue Scale (components: intensity, unpleasantness, impact on on attention). (Minimum Value : 0 means "no pain" - Maximum value : 10 means "the most intense pain imaginable").

  3. Progression of depression (Montgomery Asberg Depression Rating Scale - MADRS)

    Time frame: 2 weeks after rTMS sessions

    Progression of depression (thymia), assessed by subjective percentage improvement in mood by the MADRS. Montgomery Asberg Depression Rating Scale (MADRS) consists of 10 items to be completed during a clinical interview. Each item has a severity scale from 0 to 6, with higher scores reflecting more severe symptoms. Scores can be added together to give an overall score (from 0 to 60).

  4. Progression of depression (Beck Depression Inventory - BDI)

    Time frame: 2 weeks after rTMS sessions

    Progression of depression (thymia), assessed by subjective percentage improvement in mood by the Beck Depression Inventory (BDI). It provides a quantitative estimate of depression intensity. Each item consists of 4 sentences corresponding to 4 degrees of increasing intensity on a scale from 0 to 3. The overall score for the depressive syndrome (from 0 to 39) is obtained by adding up the scores for the 13 items.

  5. Changes in mean pain intensity

    Time frame: 2 weeks after rTMS sessions

    Comparison of changes in mean pain intensity between the two treatment arms by using Visual Analogue Scale (components: intensity, unpleasantness, impact on on attention). (Minimum Value : 0 means "no pain" - Maximum value : 10 means "the most intense pain imaginable").

  6. Evolution of catastrophism

    Time frame: 2 weeks after rTMS sessions

    Evolution of catastrophism via the Pain Catastrophizing Scale. People are asked to indicate the degree to which they have the above thoughts and feelings when they are experiencing pain using the 0 (not at all) to 4 (all the time) scale. A total score is yielded (ranging from 0-52), along with three subscale scores assessing rumination, magnification and helplessness.

  7. Evolution of affective and sensory components of pain

    Time frame: 2 weeks after rTMS sessions

    Evolution of affective and sensory components of pain via the Pain Questionnaire Saint-Antoine (QDSA). This questionnaire contains 58 words divided into 16 categories offering dimensions that to describe the painful experience

  8. Change in perceived quality of life

    Time frame: 2 weeks after rTMS sessions

    Change in perceived quality of life using the EuroQol-5D (EQ5-D). The answers given to ED-5D permit to find 243 unique health states or can be converted into EQ-5D index an utility scores anchored at 0 for death and 1 for perfect health. The EQ-5D questionnaire also includes a Visual Analog Scale (VAS), by which respondents can report their perceived health status with a grade ranging from 0 (the worst possible health status) to 100 (the best possible health status).

  9. Adverse events

    Time frame: Up to 26 weeks

    Potential adverse events reporting during the study

Study contacts

Contact information is provided by the study sponsor or research team.

Hélène RAINGARD, CRA

CONTACT

[email protected]

Roland PEYRON, PhD

CONTACT

[email protected]

(0)4 77 12 78 05 ext. +33

Sponsors and collaborators

Lead sponsor

Centre Hospitalier Universitaire de Saint Etienne

Other

Registry information

Official study title

Neuromodulation in Patients With Neuropathic Pain and Depression: a Cross-over Study Between Two Targets in Transcranial Magnetic Stimulation, the Primary Motor Cortex and the Dorsolateral Prefrontal Cortex.

Acronym: DOLODEP

Important dates

Study start
2024
Primary completion
2028
Study completion
2029
First posted
Nov 13, 2023
Registry last updated
Jul 1, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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