# An Exploratory Investigation Utilizing Repetitive Transcranial Magnetic Stimulation (rTMS) as a Tool to Decrease Pain and Improve Functioning in Veterans with Opioid Use Disorder

> **NIH VA I21** · RALPH H JOHNSON VA MEDICAL CENTER · 2021 · —

## Abstract

Opioid use disorders (OUDs) are common among Veterans. Despite the availability of opioid replacement
therapies, many individuals continue to abuse opioids and relapse rates remain high. Veterans are nearly twice
as likely to die from accidental opioid overdose than the general population. Approximately 60% of Veterans
returning from the Middle East and more than 50% of older Veterans in the VA health care system have chronic
pain. Further, post-traumatic stress disorder, a common comorbidity in the Veteran population, has been shown
to negatively impact early engagement and retention of individuals in OUD treatment. As is the case with other
substance use disorders, opioid craving is commonly described by abstinent patients whether or not they are
stabilized on buprenorphine (Northrup et al., 2015; Tsui et al., 2014). Subsequently, a treatment that reduces
pain and craving, while also improving early engagement and retention in treatment, would improve recovery
from opioid addiction.
Repetitive Transcranial Magnetic Stimulation (rTMS) is capable of non-invasively altering cortical function. rTMS
is an FDA-approved treatment for major depressive disorder. Preliminary evidence suggests that rTMS can also
reduce pain in chronic pain conditions and craving in substance use disorders. Single sessions of rTMS produce
small temporary effects, while multiple sessions of rTMS result in larger, more durable effects. Our group recently
completed a blinded, sham-controlled crossover trial in non-treatment seeking OUD participants. A single
session of rTMS reduced cue-induced craving and increased thermal pain thresholds. Given that multiple
sessions of rTMS produce larger and more durable treatment effects than single sessions of rTMS, it follows that
multiple treatment sessions applied to OUD patients may result in a clinically relevant reduction in pain and cue-
induced craving, which could improve clinical and functional outcomes.
In this SPiRE pilot proposal, we will perform a randomized, double-blind, sham-controlled trial delivering an
accelerated course of rTMS to a cohort of OUD Veterans with chronic pain receiving treatment through the Ralph
H. Johnson VA Medical Center Substance Treatment and Recovery program. The goal of this proposal is to
evaluate the feasibility and acceptability of delivering rTMS to the dorsolateral pre-frontal cortex in Veterans with
OUD and chronic pain. We will also preliminarily explore the feasibility of evaluating potential outcome
measurements in preparation for a larger trial, including abstinence, treatment retention, community reintegration
and functional outcomes, pain, and opioid craving. Positive results from this pilot project will inform a future
MERIT application and have the potential to significantly improve treatment outcomes in this difficult to treat
Veteran population.

## Key facts

- **NIH application ID:** 10337022
- **Project number:** 5I21RX003006-03
- **Recipient organization:** RALPH H JOHNSON VA MEDICAL CENTER
- **Principal Investigator:** AIMEE L MCRAE-CLARK
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-06-01 → 2021-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10337022

## Citation

> US National Institutes of Health, RePORTER application 10337022, An Exploratory Investigation Utilizing Repetitive Transcranial Magnetic Stimulation (rTMS) as a Tool to Decrease Pain and Improve Functioning in Veterans with Opioid Use Disorder (5I21RX003006-03). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10337022. Licensed CC0.

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