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RecruitingNCT04182659Updated Aug 9, 2023

Long Term Efficacy of Neuronavigation Guided rTMS in Alleviating Gulf War Illness Related Headaches and Pain Symptoms

An interventional study of Transcranial Magnetic Stimulation and Sham Transcranial Magnetic Stimulation in Gulf War Syndrome, Gulf War Illness and Headache, sponsored by Veterans Medical Research Foundation. Recruiting at 3 sites in United States. Open to participants aged 18 Years to 65 Years. Per ClinicalTrials.gov, last updated 2023-08-09.

Sponsored by Veterans Medical Research Foundation · Not applicable, Interventional, and Treatment

From the registry’s dates

  • Primary completion was expected by Sep 2023, 3 years 1 month ago, but the record still lists the study as recruiting.
  • Started Oct 2019; still recruiting 7 years 1 month later.
Phase
Not applicable
Study type
Interventional
Enrollment
150
Allocation
Randomized
Ages
18 Years to 65 Years
Sex
All
01

Study summary

This study aims to look at the long term efficacy of using repetitive transcranial magnetic stimulation (rTMS) in relieving Gulf War Illness related headaches and pain.

Read the detailed description

Headaches (HA), muscle and joint pain, are some of the most common debilitating symptoms in military personnel served in the 1990-1991 Persian Gulf War (GW1). Migraine like HA and diffuse body pain were detected in 64% of Gulf War Veteran (GWV) diagnosed with Gulf War Illness (GWI). Unfortunately, conventional pharmacological treatments for GWI-related pain has not been shown to be effective and drugs such as narcotics contain many long term untoward psychosomatic and abusive side effects. This study is assessing the effectiveness of repetitive transcranial magnetic stimulation (rTMS), non-invasive treatment option, in alleviating headaches, muscle, and joint pain symptoms of GWI.

02

Conditions studied

  • Gulf War Syndrome
  • Gulf War Illness
  • Headache
  • Muscle Pain
  • Joint Pain

Keywords

  • rTMS
  • Transcranial Magnetic Stimulation
  • Gulf War Illness
03

In context

Persian Gulf Syndrome

41 studies on the registry are indexed under Persian Gulf Syndrome; 10 are open to participants now.

This study's planned enrollment of 150 is above the median of 55 across 31 interventional studies indexed under Persian Gulf Syndrome.

Browse Persian Gulf Syndrome studies →

Lead sponsor

Veterans Medical Research Foundation is the lead sponsor of 43 studies on the registry; 9 are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years to 65 Years
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Male or female under 65 years of age who served in the military for at least 30 consecutive days between August 1, 1990, and July 31, 1991 in the Persian Gulf War region
  • Center for Disease Control (CDC) Criteria for Gulf War Illness (GWI)
  • Kansas Criteria for GWI
  • International Headache Society Criteria for Migraine Headache without aura Average Headache Exacerbation Intensity >3 on 0-10 a Numerical Pain Rating scale (NPS)
  • Average Overall Daily Muscle Pain Intensity >3 on 0-10 a NPS
  • Average Overall Daily Extremities Joint Pain Intensity >3 on 0-10 a NPS
  • Headache Exacerbation/attack 3 times per week with the average intensity >3 on a 0-10 NPS, lasting > 4 hours in the past three months
  • Hamilton Rating Scale of Depression (HRSD) \<14 based on the sum of scores for the first 17 items

Exclusion criteria

Exclusion Criteria:

  • Pregnancy
  • History of pacemaker implant
  • Any ferromagnetic (e.g. bullet fragment, shrapnel, device implant) in the brain or body that will prohibit the patients from having a brain MRI
  • History of dementia, major psychiatric diseases, or life-threatening diseases
  • Presence of any other chronic neuropathic pain states such as Complex Regional Pain Syndrome or Painful Peripheral Neuropathy
  • History of seizure
  • Pending litigation
  • Low back pain with mechanical origins such as lumbar radiculopathy or radiculitis or lumbar facet arthropathy
  • Lack of ability to understand the experimental protocol and to adequately communicate in English
  • History of Traumatic Brain injury
  • Chronic Tension or Cluster Headache
  • Ongoing Cognitive Rehabilitation or Treatment of PTSD
05

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Triple (Participant, Care provider, Investigator)
Enrollment
150 participants (estimated)

Study arms

  • Active comparator
    Active rTMS at the LMC

    Subjects will receive the repetitive Transcranial Magnetic Stimulation (rTMS) study procedure at the left motor cortex (LMC)

    Device: Transcranial Magnetic Stimulation

  • Sham comparator
    Sham rTMS at the LMC

    Sham rTMS will appear the same as the active, with the same parameters, but will not receive the actual magnetic stimulation to the LMC.

    Device: Sham Transcranial Magnetic Stimulation

Interventions

  • DeviceTranscranial Magnetic Stimulation

    A non-invasive treatment that emits magnetic pulses to stimulate the brain.

  • DeviceSham Transcranial Magnetic Stimulation

    Sham rTMS will consist of the same parameters as active, however, the subject will not receive the actual magnetic stimulation due to the use of a double sided Active/Sham coil used specifically for research studies.

06

What researchers measure

Primary outcomes

  1. Change from baseline to post treatment of GWI-related pain and headaches

    This outcome will be measured through daily self-reporting logs that tracks headache, muscle, and joint pain. A numerical rating scale of 0, being no pain, to 10, being worst possible pain, will be used to report pain and headaches.

    Time frame: Baseline, 1-week, 1-month, 2-month, and 3-month

  2. Change from baseline to post treatment of sensory and affective aspects of pain

    Short Form McGill Pain Questionnaire (SF-MPQ): This is a self-report questionnaire that allows individuals to describe the quality and intensity of pain they are experiencing. This will be used to assess the sensory and affective aspects of muscle and joint pain.

    Time frame: Baseline, 1-week, 1-month, 2-month, and 3-month

  3. Change from baseline to post treatment of headaches

    The Headache Impact Test (HIT-6) will be used to measure how headaches affect the individual's ability to function in different domains. This 6-question form assesses the severity of headache pain and is scored with a range of 36-78, with higher scores indicating a larger impact of headaches on functionality.

    Time frame: Baseline, 1-week, 1-month, 2-month, and 3-month

  4. Change from baseline to post treatment of quality of life

    The Short Form Health Survey-36 (SF-36) is a self-reported survey of patient health. It is a measure of health status and quality of life in regards to eight main areas: vitality, physical functioning, bodily pain, health perceptions, physical, emotional, and social role functioning and mental health.

    Time frame: Baseline, 1-week, 1-month, 2-month, and 3-month

  5. Change from baseline to post treatment of body pain

    A Brief Pain Inventory-Short Form (BPI-SF) questionnaire will also be used to assess the severity of pain and the impact of pain on daily functions. The BPI-SF consists of five questions. Four items measure pain on 11-point response scales from 0 to 10 ("No Pain" to "Pain as bad as you can imagine". Another item, containing 7 sub-questions, evaluates the level of pain interference with daily functioning on 11-point response scales from 0 to 10 ("Does not interfere" to "Completely interferes").

    Time frame: Baseline, 1-week, 1-month, 2-month, and 3-month

  6. Change from baseline to post treatment of muscle pain

    The New Clinical Fibromyalgia Diagnostic Criteria - Part 1 will be used to assess muscle pain. Patients will be asked to rate the average (over the past 24 hours) intensity of muscle pain for up to 12 locations of the body.

    Time frame: Baseline, 1-week, 1-month, 2-month, and 3-month

  7. Change from baseline to post treatment of fibromyalgia

    A Revised Fibromyalgia Impact Questionnaire will be used to evaluate the function, overall impact and symptoms of Fibromyalgia. There are a total of 21 questions, each with a range of 0-10, with 10 being either "very difficult" or "always."

    Time frame: Baseline, 1-week, 1-month, 2-month, and 3-month

  8. Change from baseline to post treatment of neurobehavioral symptoms

    Baseline, 1-week, 1-month, 2-month, and 3-month

    Time frame: The Neurobehavioral Symptoms Inventory (NSI) is a self-report questionnaire on the severity of various behavioral symptoms and is measured using a 5-item scale. It asks the subjects to indicate the extent to which each symptom has disturbed them.

  9. Change from baseline to post treatment of sleep quality

    The Pittsburgh Sleep Quality Index (PSQI) questionnaire has nineteen individual items which are used to generate seven composite scores on: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. Questions are either free-response or have a range from 0-3, with 3 being "more frequent" or "very bad."

    Time frame: Baseline, 1-week, 1-month, 2-month, and 3-month

  10. Change from baseline to post treatment of sleep difficulties

    The Insomnia Severity Index measures the severity of an individual's sleep difficulties. All questions range from 0-4 and the sum of the answers would give the total score. The total score range from 0-28.

    Time frame: Baseline, 1-week, 1-month, 2-month, and 3-month

  11. Change from baseline to post treatment of fatigue

    The Flinders Fatigue Scale measures daytime fatigue associated with insomnia through a 7-item questionnaire. The questions range from 1-5, with 5 being "extremely" or "entirely."

    Time frame: Baseline, 1-week, 1-month, 2-month, and 3-month

Secondary outcomes

  1. Change from baseline to post treatment of PTSD symptoms

    The Clinician-Administered PTSD Scale (CAPS-5), 30-item structured interview that can be used to diagnose PTSD and associated symptoms, will be used to assess PTSD symptoms

    Time frame: Baseline, 1-week, 1-month, 2-month, and 3-month

  2. Change in opioid-based pain medication usage

    Medication assessment consists of daily chronic and breakthrough opioid usage for pain or headache. Average daily dosage will be converted to equal-potent oral Morphine Sulfate dosage based on the clinical opioid conversion table used by the VA San Diego Healthcare System Pain Service and University of California, San Diego, Center for Pain Medicine. The study participants will be asked to remain on the same analgesic medication(s) during the study period but are allowed to titrate down their narcotic usage.

    Time frame: Baseline, 1-week, 1-month, 2-month, and 3-month

  3. Explore changes in supraspinal resting state functional connectivity

    The outcome measure will be assessed through functional magnetic imaging scans and subsequent processing.

    Time frame: Baseline and 1-week post treatment

07

Study locations

3 of 3 sites recruiting
  • VA Palo Alto
    Palo Alto, California 94304, United States
    Recruiting
    • Valentino Basilio · ContactVbasilio@pavir.org · 650-514-6614
    • Maheen Adamson, PhD · Principal investigator
  • VA San Diego Healthcare System
    San Diego, California 92161, United States
    Recruiting
    • Caleb Lopez, BS · Contactcaleb.lopez@va.gov · 858-552-8585
    • Albert Y Leung, MD · Principal investigator
  • VA Atlanta
    Decatur, Georgia 30033, United States
    Recruiting
    • Carly Ragin, BS · ContactCarly.Ragin@va.gov · 404-321-6111
    • Anna Woodbury, MD · Principal investigator
08

References and documents

Individual participant data

Plan to share: No

No publications or documents are linked to this record.

09

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Aug 9, 2023, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT04182659
Lead sponsor
Veterans Medical Research Foundation
Collaborators
United States Department of Defense
Responsible party
Sponsor
First posted
Dec 2, 2019
Start date
Oct 1, 2019
Primary completion
Sep 30, 2023 (estimated)
Completion
Sep 30, 2023 (estimated)
Last update
Aug 9, 2023

Study contacts

Caleb Lopez, BS
Contact
caleb.lopez@va.gov
858-552-8585 ext. 2638
Albert Leung, M.D.
principal investigator · San Diego Veterans Healthcare System

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
Yes
View the source record on ClinicalTrials.gov ↗

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