PERSONALIZED NON-INVASIVE NEUROMODULATION IN PAIN

Chronic pain (CP) is the most prevalent disease worldwide and is a major societal challenge. Different people with the same pain condition experience it differently. Irrespective of its origin, CP is maintained by altered connectivity between brain regions, which can be modulated towards normality by effective treatment. Several pharmacological and non-pharmacological strategies exist to treat pain, but 40% of individuals remain symptomatic despite treatment. Current treatment for CP is not personalised, being delivered in a standardised regimen irrespective of patients' brain network status, which partially justifies therapeutic refractoriness. Non-invasive neuromodulation (NIN) techniques such as repetitive transcranial magnetic stimulation (rTMS) are used in the long-term treatment of a wide spectrum of brain disorders as an alternative to medication-exclusive regimens. NIN can modulate altered connectivity towards normal patterns and relieve symptoms with minimal side effects, but to date its application has also been non-individualized, which equally impacts its therapeutic potential. I propose a comprehensive package of studies using measurements of local-to-global brain connectivity to individualize pain treatment. By probing different brain regions by single pulse-TMS and reading the subsequent brain oscillatory responses by electroencephalography, one can screen potential treatment targets and classify them according to their efficacy potential in a pre-treatment session. This will allow the identification of the best cortical region to be used as treatment target by rTMS, thus providing a personalized choice of the ideal entry-spot to drive brain global connectivity towards normalized patterns for each patient.With the development local-to-general brain connectivity metrics guiding NIN treatment, PersoNINpain will provide an innovative and ground-breaking approach to transform the treatment the world’s most impactful health condition - chronic pain.