Miller, Jillian VinallRasic, NivezEpp, Spencer Daniel2024-02-142024-02-142024-02-09Epp, S. D. (2024). Addition of repetitive transcranial magnetic stimulation to intensive interdisciplinary pain treatment for youth with chronic pain (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.https://hdl.handle.net/1880/118177https://doi.org/10.11575/PRISM/43021Background: Pediatric chronic pain is highly prevalent. The current gold standard of treatment are Intensive Interdisciplinary Pain Treatment (IIPT) programs, providing a multimodal range of therapies over a short time frame. Repetitive transcranial magnetic stimulation (rTMS) of the middle frontal gyrus (MFG) has been shown to be a safe and effective treatment for adults with chronic pain but has not yet been used in youth chronic pain populations. Justifying the use of rTMS to the MFG and determining the safety and tolerance of this application in a pediatric population is critical to advancing pediatric chronic pain management. Methods: 20 youth with chronic pain aged 12-18 years underwent fMRI task-based neuroimaging and completed pain questionnaires before and after IIPT at the Alberta Children’s Hospital. These patients were assessed for changes in brain response to emotional stimuli following treatment in absence of rTMS, and these brain changes were compared to changes to pain interference. 15 further patients completed the IIPT program with the inclusion of rTMS as an additional therapy and were assessed for their tolerance of rTMS and attitude towards the treatment. Results: The non-rTMS group demonstrated a significant positive correlation between a reduction in pain interference and a decrease in MFG activity over the course of treatment. The rTMS group reported similar reductions in pain interference and no major adverse events. Although uncommon, headache, light-headedness, and neck pain were the most frequently reported adverse symptoms. Neck pain was the only symptom found to be consistently exacerbated by rTMS. Pre-IIPT, participants generally expected rTMS to provide great benefit, but post-IIPT reported physio- and psychotherapies as most helpful to their recovery. Conclusions: The fMRI results from the non-rTMS group help justify the use of rTMS in the IIPT. rTMS does not appear to influence established outcomes of the IIPT positively or negatively at this time, though greater sample sizes are needed for more powerful analyses. Action should be taken to minimize minor adverse symptoms during stimulation, however, rTMS is shown to be broadly safe and tolerable for this youth chronic pain population. Future analyses should focus on the magnitude and longevity of influence of rTMS on IIPT outcomes.enUniversity of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.Repetitive Transcranial Magnetic StimulationPediatric chronic painMagnetic Resonance ImagingIntensive interdisciplinary pain treatmentNeuroscienceBiophysics--MedicalMental Healthmaster thesis