NCT07158567

Brief Summary

The objectives of this VA Merit application are to demonstrate efficacy of combined intermittent theta burst (iTBS) and yoga (iTBS+yoga) intervention on improving pain, function, analgesic use, self-efficacy, quality of life and well-being among Veterans with chronic low back pain (CLBP). This Merit project will directly benefit Veterans and VA Services by demonstrating efficacy of a new, non-medication treatment for Veterans with CLBP in need of non-opioid treatment options. Neuromodulation including iTBS is now offered at over 50 VA hospitals and yoga is among the complementary and integrative health programs being rolled out as a part of VAs Whole Health implementation efforts. Thus, should iTBS+yoga ultimately prove to be efficacious, VA facilities will be well-poised to offer this treatment. A novel, activity-based, non-medication treatment for Veterans with CLBP is of great need given the high prevalence of CLBP.

Trial Health

63
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Trial Health Score

Automated assessment based on enrollment pace, timeline, and geographic reach

Enrollment
213

participants targeted

Target at P25-P50 for phase_3

Timeline
68mo left

Started Jun 2026

Longer than P75 for phase_3

Geographic Reach
1 country

2 active sites

Status
not yet recruiting

Health score is calculated from publicly available data and should be used for screening purposes only.

Trial Relationships

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Study Timeline

Key milestones and dates

First Submitted

Initial submission to the registry

August 28, 2025

Completed
11 days until next milestone

First Posted

Study publicly available on registry

September 8, 2025

Completed
9 months until next milestone

Study Start

First participant enrolled

June 1, 2026

Expected
5 years until next milestone

Primary Completion

Last participant's last visit for primary outcome

June 1, 2031

7 months until next milestone

Study Completion

Last participant's last visit for all outcomes

December 31, 2031

Last Updated

September 8, 2025

Status Verified

August 1, 2025

Enrollment Period

5 years

First QC Date

August 28, 2025

Last Update Submit

August 28, 2025

Conditions

Keywords

chronic low back paintranscranial magnetic stimulationTMSneuromodulationyogacomplementary and integrative healthmusculoskeletal pain

Outcome Measures

Primary Outcomes (2)

  • Brief Pain Inventory - Pain Severity

    The Brief Pain Inventory is a self-report measure of pain symptoms throughout the body. It has 4 main items related to pain severity and each item is scored on a scale of 0 to 10 with 0 meaning no pain (better), and 10 meaning pain as bad as you can imagine (worse). Minimum (best) score would be 0 and maximum (worst) score would be 40.

    Baseline (Pre-intervention, Endpoint (after last iTBS+yoga treatment, approximately 6 weeks), Follow-Up at 1 week, 2 weeks, 6 weeks and 6 months post-treatment

  • Brief Pain Inventory - Pain Interference

    The Brief Pain Inventory is a self-report measure of pain symptoms throughout the body. t has 7 main items related to pain interference and each item is scored on a scale of 0 to 10 with 0 meaning "Does not interfere", and 10 meaning "Completely Interferences". Minimum (best) score would be 0 and maximum (worst) score would be 70.

    Baseline (Pre-intervention, Endpoint (after last iTBS+yoga treatment, approximately 6 weeks), Follow-Up at 1 week, 2 weeks, 6 weeks and 6 months post-treatment

Secondary Outcomes (7)

  • PROMIS Pain Interference - Short Form 6b

    Baseline (Pre-intervention, Endpoint (after last iTBS+yoga treatment, approximately 6 weeks), Follow-Up at 1 week, 2 weeks, 6 weeks and 6 months post-treatment

  • PROMIS Physical Function with Mobility Aid

    Baseline (Pre-intervention, Endpoint (after last iTBS+yoga treatment, approximately 6 weeks), Follow-Up at 1 week, 2 weeks, 6 weeks and 6 months post-treatment

  • Wellbeing Signs Tool

    Baseline (Pre-intervention, Endpoint (after last iTBS+yoga treatment, approximately 6 weeks), Follow-Up at 1 week, 2 weeks, 6 weeks and 6 months post-treatment

  • Pain Self-Efficacy Questionnaire

    Baseline (Pre-intervention, Endpoint (after last iTBS+yoga treatment, approximately 6 weeks), Follow-Up at 1 week, 2 weeks, 6 weeks and 6 months post-treatment

  • Veterans Rand 36 Item Health Survey (VR-36)

    Baseline (Pre-intervention, Endpoint (after last iTBS+yoga treatment, approximately 6 weeks), Follow-Up at 1 week, 2 weeks, 6 weeks and 6 months post-treatment

  • +2 more secondary outcomes

Study Arms (3)

active-iTBS+yoga

EXPERIMENTAL

real or active intermittent theta burst stimulation provided prior to participation in small group LoveYourBrain Yoga program class

Device: intermittent theta burst stimulationBehavioral: LoveYourBrain Yoga Program

sham-iTBS+yoga

PLACEBO COMPARATOR

fake, inactive or sham intermittent theta burst stimulation (designed to look, sound and feel like real or active stimulation) provided prior to participation in small group LoveYourBrain Yoga program class

Device: intermittent theta burst stimulationBehavioral: LoveYourBrain Yoga Program

active-iTBS alone

ACTIVE COMPARATOR

real or active intermittent theta burst stimulation alone (no yoga participation)

Device: intermittent theta burst stimulation

Interventions

Transcranial magnetic stimulation (TMS) is a non-invasive neuromodulatory treatment. TMS has been FDA cleared since 2008 for treatment resistant depression. It is now FDA cleared for a few other indications including migraine. Magnetic pulses are delivered through a coil placed on the scalp and when the magnetic field reaches brain cells, it changes to an electric current that can increase or decrease excitability depending on the treatment parameters. Intermittent theta burst stimulation (iTBS) is a type of patterned, excitatory TMS. iTBS only takes 3 minutes to deliver and is theorized to induce a window of neuroplasticity that lasts at least 1 hour. The Magventure with Magoption x100 Stimulator and associated coil the investigators are using can be set to deliver active (real) or sham (fake or inactive) TMS. The sham device is designed to look, sound and feel like real TMS.

Also known as: transcranial magnetic stimulation (TMS), Magventure
active-iTBS aloneactive-iTBS+yogasham-iTBS+yoga

This yoga program is evidence-based, standardized and manualized. It is developed by the LoveYourBrain Foundation (www.loveyourbrain.com). Each yoga session includes 10 min of breathing exercises, 45 min of gentle yoga or stretching exercises, 15 min of guided meditation, and 20 min of facilitated discussion with psychoeducation, detailed in a manual to ensure standardization of program content across time and instructors.

Also known as: yoga, hatha-based yoga
active-iTBS+yogasham-iTBS+yoga

Eligibility Criteria

Age22 Years+
Sexall
Healthy VolunteersNo
Age GroupsAdult (18-64), Older Adult (65+)

You may qualify if:

  • mo. stability in pain management strategies.
  • + years of age.
  • Can read and speak English.
  • Able to participate in strengthening, stretching, range of motion exercise via yoga as determined by study physician.
  • Chronic Low Back Pain (CLBP): pain in the low back that persists for \>6 months and is of moderate to severe intensity with a score of \>5 on specific items on the BPI demonstrating disability of at least 20% on the Oswestry Disability Index (ODI).

You may not qualify if:

  • Contraindications to iTBS/TMS (e.g. epilepsy, psychotic spectrum disorders \[i.e. bipolar, schizophrenia\], history of anoxic brain injury).
  • Moderate to severe heart disease.
  • Contraindications to MRI (e.g., claustrophobia, implanted ferromagnetic device such as pacemaker or cardiac defibrillator).
  • Pain believed to be associated with cardiac or ischemic conditions.
  • Epilepsy, active seizure disorder, personal history of a seizure or individuals with a family history of epilepsy or seizure in a first degree relative.
  • Current prescription of psychostimulants (e.g., amphetamines), anticholinergics, tricyclic antidepressants, and antipsychotics or other medications that may increase their risk of having seizures.
  • Intracranial lesion.
  • History of ischemic or hemorrhagic stroke.
  • History of moderate to severe TBI.
  • History of or current psychosis not due to an external cause (e.g., due to illicit drug use).
  • Other neurological conditions (e.g., neurodegenerative disorders).
  • Active suicidal ideation with Columbia Suicide Severity Rating Scale(CSSRS) 3 .
  • Are pregnant or nursing.
  • Within 12 weeks of a major surgery/operation.

Contact the study team to confirm eligibility.

Sponsors & Collaborators

Study Sites (2)

Jesse Brown VA Medical Center, Chicago, IL

Chicago, Illinois, 60612, United States

Location

Edward Hines Jr. VA Hospital, Hines, IL

Hines, Illinois, 60141-3030, United States

Location

Related Links

MeSH Terms

Conditions

Musculoskeletal Pain

Interventions

Transcranial Magnetic StimulationYoga

Condition Hierarchy (Ancestors)

Muscular DiseasesMusculoskeletal DiseasesPainNeurologic ManifestationsSigns and SymptomsPathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Magnetic Field TherapyTherapeuticsMind-Body TherapiesComplementary TherapiesSpiritual TherapiesExercise Movement TechniquesPhysical Therapy Modalities

Study Officials

  • Amy A Herrold, PhD BA

    Edward Hines Jr. VA Hospital, Hines, IL

    PRINCIPAL INVESTIGATOR

Central Study Contacts

Amy A Herrold, PhD BA

CONTACT

Study Design

Study Type
interventional
Phase
phase 3
Allocation
RANDOMIZED
Masking
TRIPLE
Who Masked
CARE PROVIDER, INVESTIGATOR, OUTCOMES ASSESSOR
Masking Details
The PI, study statistician, intervention providers, and those collecting study data will be blind to treatment assignment. While participants may be able to discern whether or not they received iTBS alone because there is no yoga component (thus, the single blind), they may not be able to guess if they received active-iTBS+yoga vs. sham-iTBS. Participants will complete a blinding questionnaire after completion of the study intervention. After follow up, the study team will become unblinded to provide participants with the opportunity to complete their preferred intervention types. The study statistician will remained blinded.
Purpose
TREATMENT
Intervention Model
PARALLEL
Model Details: single, blind, randomized, 3 parallel group design: (1) active-iTBS+yoga, (2) sham-iTBS+yoga, and (3) active-iTBS alone
Sponsor Type
FED
Responsible Party
SPONSOR

Study Record Dates

First Submitted

August 28, 2025

First Posted

September 8, 2025

Study Start (Estimated)

June 1, 2026

Primary Completion (Estimated)

June 1, 2031

Study Completion (Estimated)

December 31, 2031

Last Updated

September 8, 2025

Record last verified: 2025-08

Data Sharing

IPD Sharing
Will not share

Locations