Bone fracture is the most common type of orthopedic trauma (OT), accounting for 30 million cases in the United States each year. Pain management is a priority of care after OT due to its beneficial effects on healing, comfort, motor and cognitive recovery. Persistent pain or functional deficits are experienced in 30-50% of isolated limb fracture (ILF) cases, and lost work time accounts for most of its staggering financial burden. Concomitant mild traumatic brain injury (mTBI) (ILF+mTBI) nearly triples the time taken to return to work and self-reported pain symptoms are significantly higher at 3 months postinjury, thus making mTBI a highly prevalent and putative risk factor of poor prognosis after ILF. Inhibiting neuroinflammation (NI) is a promising clinical target to reduce pain symptoms after ILF.
There exists medications that are effective in reducing NI, but their significant side effects restrict long-term use. A multi-session non-invasive brain stimulation protocol called prolonged continuous theta-burst stimulation (pc-TBS) was shown to provide long-lasting analgesic effects. To date, no study has performed a longitudinal investigation of the analgesic effect of pc-TBS in ILF patients. Within 48 hours of injury (baseline), recruited ILF and ILF+mTBI patients will be studied on injury markers. Half of subjects from each group will undergo a 10-day pc-TBS protocol, while the other half will be assigned to a sham protocol. All subjects will be followed at 1, 3, and 12 months post-injury.
The application of pc-TBS to trauma patients could provide a much needed therapeutic alternative to reducing pain symptoms. In pc-TBS, adverse effects are minimal and functional gains are expected with the facilitation of brain plasticity mechanisms. By targeting all 4 major obstacles preventing trauma recovery, pc-TBS is likely to reduce the time taken to return and in so doing, its staggering financial burden.