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MUSC study targets helping veterans use fewer pain pills

Helen Adams | MUSC News Center | October 27, 2014


TMS Veterans Depression
Photos by Helen Adams

 
Jeffrey Borckardt, Ph.D., shows the tDCS equipment he’ll use to test whether using brain stimulation in conjunction with psychotherapy can reduce veterans’ reliance on pain medications. 

Researchers at the Medical University of South Carolina will be part of a $21.7 million federal initiative aimed at finding alternatives to addictive painkillers for thousands of veterans suffering from pain related to their military service.

MUSC will seek volunteers for its study in January, specifically veterans whose doctors have prescribed opiates to treat their chronic pain. Those veterans will sit with electrodes strapped to their heads for 20 minutes per session while electric current flows to a targeted area of the brain. Researchers hope the treatment called transcranial direct current stimulation (tDCS) will help reduce their pain and their cravings for opiates.

Jeffrey Borckardt, Ph.D., director of the Biobehavioral Medicine Division at MUSC, will lead the trial. He specializes in researching treatments for chronic pain. “We think that by helping them manage their pain better non-pharmacologically, with the electricity and the combined psychotherapy, the pain will be under better control,” he said. “They’ll be less likely to misuse their medications."

His idea is that tDCS, a form of neurotherapy, can “prime” the veterans’ brains, reducing their pain and making them more receptive to cognitive behavioral therapy, which is also part of his study. Cognitive behavioral therapy is a form of talk therapy aimed at controlling and changing negative thoughts and behavior. By itself, this form of therapy has been shown to help people better manage chronic pain, but it is hoped that combining it with tDCS will provide even greater pain relief.

“We’re building on some techniques that are reasonably well established," Borckardt said of the brain stimulation techniques MUSC has been instrumental in pioneering. Borckardt said there is evidence suggesting that tDCS alone can reduce pain. One of his recent studies showed that using tDCS on people who have had surgery reduced their use of opiate pain medication by as much as 40 percent.

TDCS equipment 
In tDCS or transcranial direct current stimulation, sensors are placed on the scalp based on what area of the brain is being targeted. 

He also said tDCS itself is not considered painful. “Some patients report tingling, itching, and in a few cases, a mild burning sensation that typically subsides in about 30 seconds.”

He’s tried it on himself to understand how it might feel to patients. “It makes me a little sleepy. That might be endogenous opiates – they might do that to some people.”

Endogenous opiates are sometimes called the body’s most powerful painkillers, and Borckardt said they may be released as a result of using tDCS.

The treatment also changes the brain’s concentrations of the neurochemicals GABA (gamma amino butyric acid) and glutamate. GABA can calm nervous activity, while glutamate is associated with learning and memory.

Borckardt, who also serves as assistant professor in MUSC's Department of Psychiatry and Behavioral Sciences, hopes the federal initiative that includes his study will lead to new pain treatments for veterans and others in chronic pain.

“The trouble is, right now, there aren’t many options for treating pain, so a lot of people have to rely on medication,” Borckardt said. “A subset of those patients falls down this hole of aberrant use and misuse, and it gets out of control.”

Other research covered by the federal initiative includes a study of whether bright morning light can reduce low-back pain and post-traumatic stress disorder symptoms and a project testing whether mobile devices that show brain activity can help veterans know when to relax to reduce pain symptoms.

Read about all 13 of the projects included in the federal program here: http://nccam.nih.gov/news/press/09232014

 

 

 

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