Combining Repetitive Transcranial Magnetic Stimulation (rTMS) with Corticosteroid Joint Injections (CJI) for the Treatment of Chronic Axial Pain (CAP): A Pilot Double-blinded Randomized-Controlled Trial

Chronic axial pain (CAP) is a debilitating condition impacting millions globally, with traditional treatments providing only short-term relief. This pilot study explored the primary outcomes of feasibility, tolerability, and safety, as well as the secondary outcomes of pain intensity, disability, quality of life, and patients’ perceived response to the combined intervention of repetitive transcranial magnetic stimulation (rTMS) and corticosteroid joint injections (CJI) as a novel approach to address CAP. Sixteen participants from St. Joseph’s Healthcare Pain Clinic were randomized (1:1) to receive 11 active or sham rTMS sessions over 12 weeks, with follow-up until week 24 or their next CJI, whichever came first. Feasibility was assessed through dropout rates, session and assessment completeness, and screening-to-enrollment ratios. Tolerability was rated on a 1-5 scale, and safety was assessed based on reported adverse effects. Although secondary outcomes showed no significant differences between the treatment groups, the results support the feasibility, tolerability, and safety of combining rTMS with CJI, warranting a larger clinical trial to explore the question of clinical efficacy.