Safety and feasibility of a combined neuromodulation and yoga intervention for individuals with mild traumatic brain injury and chronic pain: a pilot study

The complex clinical presentation of patients with mild traumatic brain injury and chronic pain (mTBI+CP) often causes symptoms that are resistant to standard treatments. For the first time, our team combined intermittent theta burst stimulation and yoga (iTBS+LYB) to maximize treatment effect and promote functional recovery in a pilot open-label clinical trial among Veterans with mTBI+CP. A 3-minute iTBS protocol was delivered including 3 pulses of stimulation given at 50Hz, repeated every 200ms at 80% of the resting MT, with an inter-pulse-interval of 20ms. A 2s train of iTBS was repeated every 10s for a total of 190s, for a total of 600 pulses. After all participants received iTBS, a certified yoga instructor guided a 90-minute group LYB session. N=19 participants were enrolled; 71.4% (10/14) completed all 6 iTBS+LYB sessions. Three individuals experienced headaches, a known side effect of iTBS, which resulted in one participant self-withdrawing. iTBS+LYB for mTBI+CP is feasible and safe, with known side effects.