Improving functions in Veterans with Post-Traumatic Peripheral Neuropathic Pain

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Abstract Over 30% of neuropathic pain conditions in Veterans are due to peripheral nerve injury from physical or surgical related trauma. Peripheral nerve injury often results in the formation of neuroma/nerve entrapment, a persistent neuropathic pain state accompanied by sensory hypersensitivity and uncontrollable spontaneous pain sensation at the injury site. Current available medications for neuropathic pain often consist of untoward side effects and/or abusive risks. Invasive measures such as surgical resection or local injections of steroid and local anesthetics at the injury/neuroma site are often ineffective in alleviating the symptoms and the invasive nature of the procedure is usually painful for the patients. Therefore, there is a need in the field of pain management in developing means of non-invasive and non-contact therapy in treating post-traumatic peripheral neuropathic pain (PTP-NP) states. The pain service at the VA San Diego Healthcare System (VASDHS) has recently adopted the use of transcutaneous magnetic stimulation (tMS) in treating PTP-NP and noticed encouraging pain relief benefit in patients with PTP-NP. The PI also completed a mechanistic nerve conduction study and showed that this treatment method can potentially restore lost neuronal functions associated with PTP-NP. Our initial pilot data from a randomized controlled study support the feasibility of conducting a larger scale randomized controlled clinical trial to adequately assess the effect of tMS in treating PTP-NP and improving patients' function. To validate tMS as a non-contact and non-invasive pain treatment option for reducing pain in Veterans with PTP-NP and improving their overall functions, the proposed study will assess: 1) the effect of transcutaneous magnetic stimulation (tMS) in alleviating post-traumatic peripheral neuropathic pain (PTP-NP); 2) the effect of tMS in improving quality of life and functions in Veterans with PTP-NP.