A Transdisciplinary Collaborative Study of mTBI and Chronic Pain Using iTBS and Yoga

Mild traumatic brain injury (mTBI) with comorbid chronic pain causes significant health challenges, necessitating creative treatment strategies. A transdisciplinary study team comprised of neuropsychologists, yoga instructors, health services researchers and implementation scientists, and physical, occupational, and speech therapists developed and tested a novel nonpharmacological treatment option for chronic pain. Objective: The parent pilot study (clincaltrial.gov #NCT04517604) explored the effects of intermittent theta burst stimulation (iTBS; a type of transcranial magnetic stimulation) to have an additive effect on the neural circuits with yoga on Quality of Life (QoL), function, and pain among Veterans with mTBI and chronic musculoskeletal pain. In the present sub-analysis, we focused on gaining a deeper insight into the QoL results. Methods: Utilizing an open-label trial design, 10 Veterans received iTBS before participating in a TBI-specific yoga program, LoveYourBrain Yoga. The Farmer triangulation method was used to compare qualitative and quantitative outcomes. Outcome measures included self-reported symptom scales and post-participation semi-structured qualitative interviews. Results: Participants reported that iTBS prepared their brains for yoga and increased their confidence in self-management of pain post-participation. This was confirmed with TBI QoL subscales (t(9)=2.03; p=0.02) and as reported with the participant's self-report. However, TBI QoL composite scores did not agree (t(9)=-5.17, p=0.65) nor capture the role iTBS + Yoga had on participants' increased confidence in self-management of health and non-pharmacological pain management. Conclusion: Our results suggest integrating advanced neurological technologies with complementary health therapies such as yoga presents a creative, transdisciplinary approach to nonpharmacologic rehabilitation for chronic pain.