# Feasibility of combination exercise and neuromodulation rehabilitation to improve post-stroke chronic pain

> **NIH VA I21** · BIRMINGHAM VA MEDICAL CENTER · 2023 · —

## Abstract

There are over 7 million stroke survivors in the United States. In the Veteran population,
stroke is the leading cause of neurological disability, and one of leading causes of
hospitalization. Chronic pain after stroke can occur between 10-50% of stroke survivors. Post-
stroke pain (PSP) can lead to further complications in a stroke survivor’s recovery. Exercise has
been shown to improve pain symptoms of patients with PSP. the American Heart/Stroke
Association recommended that exercise should be incorporated into the management of stroke
survivors. Repetitive transcranial magnetic stimulation (rTMS) uses noninvasive cortical
neurostimulation to improve neuropathic pain. A European commission to establish guidelines
on therapeutic use of rTMS stated the evidence of rTMS of the contralateral primary motor
cortex as definite analgesic effect with few safety issues (Level A recommendation). However,
the effects of the treatment are transient, usually lasting a few hours to days[20]. While non-
invasive, as a practical therapy for chronic PSP, more sustained efficacy of rTMS would be
needed to be demonstrated. We hypothesize that pairing rTMS with exercise may develop a
complementary effect to enhance the duration of symptomatic relief.
 This proposal is a single-site, randomized sham-controlled trial of rTMS and exercise in the
treatment of Veterans with a diagnosis of chronic PSP who are at least 6-months from their
cerebral stroke. The purpose of the pilot study is to evaluate the feasibility and safety of
rTMS+exercise in Veterans diagnosed with chronic PSP. We will gather data to plan for a larger
efficacy trial to assess sustained rTMS effects with exercise on pain outcomes. The long-term
goal of the proposed work is to develop a non-pharmacologic intervention that also increases
physical activity for patients suffering from chronic PSP. Following successful screening and
baseline randomization, eligible patients will be treated with a regimen of rTMS vs sham rTMS
for 1 week. Participants return for assessments at the end of week 1 and continue the assigned
rTMS arm while adding supervised aerobic exercise 3 times weekly from week 2 to 9. Final
assessment is at 3 months.
Aim 1: Evaluate the feasibility of an efficacy study design comparing rTMS and exercise versus
sham rTMS and exercise to reduce pain in patients with chronic PSP.
 Hypothesis 1: The pace of recruitment will be acceptable. We will recruit 36 patients, 32 of
 whom will complete the study within 3 months.
Aim 2: Evaluate the safety of rTMS combined with aerobic exercise in patients with a history of
ischemic stroke and chronic PSP.
 Hypothesis 2: Less than 10% of patients randomized to combined intervention of aerobic
 exercise plus rTMS will have adverse events and the observed rate will be comparable to
 patients randomized to aerobic exercise plus sham rTMS.
Aim 3: To assess the correlation between neuronal connectivity of the motor cortex with pain and
stroke outcomes following...

## Key facts

- **NIH application ID:** 10734040
- **Project number:** 5I21RX003612-03
- **Recipient organization:** BIRMINGHAM VA MEDICAL CENTER
- **Principal Investigator:** Chen Lin
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2023
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2021-07-01 → 2024-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10734040

## Citation

> US National Institutes of Health, RePORTER application 10734040, Feasibility of combination exercise and neuromodulation rehabilitation to improve post-stroke chronic pain (5I21RX003612-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10734040. Licensed CC0.

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