IMAGE: The motor cortex is located near the middle of the skull, and the DLPFC is closest to the front. An electromagnetic coil is then placed against the head and magnetic … seen most
Credit: Hanlon Lab
The researchers found that there may be a new pathway in the brain that provides pain relief and reduces the desire for opioids.
More than a third of the US population suffers from chronic pain, with little or no relief reported with the medication. Transcranial magnetic brain stimulation (TMS) is a non-invasive form of brain stimulation that can offer a new treatment option for these underserved members of our community.
In a recent article in Drug and Alcohol Addiction, researchers at the Medical University of South Carolina evaluated two different strategies to relieve pain with TMS: the application of TMS in the motor cortex and in the dorsolateral prefrontal cortex (DLPFC).
Colleen Hanlon, Ph.D., professor in the department of psychiatry and behavioral sciences at MUSC and principal investigator for this article, hoped to support his hypothesis that DLPFC would be the most effective target for the treatment of STM, but the results show just the opposite .
Historically, TMS-based treatments have targeted DLPFC. In addition to being an FDA approved target for controlling depression, the data show that DLPFC is important in regulating emotions, as well as in addiction to substances such as tobacco, cocaine and alcohol. Although the motor cortex has been a popular target for STM pain relief studies, there was no data to suggest that it could also be useful in opioid users. The new study points to its success as a goal.
“I think you can even argue that our data suggest that the motor cortex is a neglected region of the brain in terms of developing addiction treatment,” said Julia Imperatore, research coordinator at MUSC and laboratory manager for this study. Hanlon agrees.
The head of each study participant was mapped with coordinates to target specific areas of the brain using a cap marked with a permanent marker. Head circumferences differ between individuals and, therefore, also the locations of the motor cortex and DLPFC. The motor cortex is located near the middle of the skull and the DLPFC is closest to the front. Once these locations are determined, an electromagnetic coil is placed against the head, and magnetic pulses are sent painlessly and non-invasively through the skull to stimulate nerve cells in the brain.
After two weeks of administering daily TMS sessions and daily assessments of opioid pain and desire, Hanlon’s research team reported a significant difference in effects between the two sites. The motor cortex was significantly more effective in reducing the study participant’s desire to use opioids and pain perception, both immediately after treatment and during follow-up assessments. Direct magnetic stimulation to the motor cortex led to a 64-70% reduction in pain.
“This is the first study to evaluate a non-invasive therapeutic treatment to help decrease opioid use in patients with chronic pain,” said Hanlon. “We don’t have non-pharmacological treatment options for people, and people are really tired of taking pills.”
As a pilot study, the article by Hanlon and Imperatore opens a new area of research. It represents the first attempt at random comparison of these two potential treatment targets and Hanlon’s enthusiasm because it suggests that the motor cortex is an important and influential part of the addiction process.
“Not only pain, but also the desire to use opiates in this case,” she said. “It is a new window of opportunity that we can explore.”
Imperatore will conduct future studies to expand knowledge on the topic, as this pilot study used a small sample. MUSC will be conducting studies together with Wake Forest School of Medicine and hopes to offer this new therapeutic option to patients suffering from chronic pain and addiction in the near future.
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As the clinical health system at the Medical University of South Carolina, MUSC Health is dedicated to providing the highest quality patient care, while training generations of competent and compassionate health professionals to serve the people of South Carolina. South and beyond. Comprised of approximately 1,600 beds, over 100 extension sites, MUSC College of Medicine, the doctors’ practice plan and almost 275 telehealth locations, MUSC Health owns and operates eight hospitals located in Charleston, Chester, Florence counties , Lancaster and Marion. In 2020, for the sixth consecutive year, the US News & World Report named MUSC Health the number one hospital in South Carolina. To learn more about clinical patient services, visit muschealth.org.
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