Clinical Research Directory

Inclusion Criteria: * Ages 18 years or older * Ability to provide written informed consent * Ability to read and to communicate verbally and in writing in English * Chronic pain persisting for at least 12 months * Pain refractory to oral pain medication (defined as failing at least two different medication classes) * Average pain intensity of ≥5 on the Numerical Rating Scale (NRS) over the past two weeks * Stable pain medication regimen for at least 4 weeks prior to enrollment * Willing and able to attend all study visits and comply with study procedures Exclusion Criteria: * Current substance use disorder (except for nicotine or cannabis) as determined by DSM-5 criteria * Active suicidal ideation with intent or plan as determined by the Columbia-Suicide Severity Rating Scale (C-SSRS) * Lifetime history of bipolar disorder, schizophrenia, or other psychotic disorder as determined by medical history * Self-reported unstable medical conditions that would pose increased risks for TMS or MRI * Pregnancy (as determined by urine pregnancy test) or planned pregnancy during the study period * Contraindications to TMS, including: * History of seizure or epilepsy * Metallic implants in the head (excluding dental fillings) * Cardiac pacemaker or other implanted medical devices * History of significant head trauma * History of intracranial surgery * Medication that significantly lowers seizure threshold that cannot be safely held * Contraindications to MRI, including: * Claustrophobia * Metallic implants or devices * Inability to lie flat for the duration of the scan * Current use of high-dose opioids (\>90 morphine milligram equivalents daily) * Participation in another clinical trial of an investigational medication or device within 30 days prior to enrollment * Any condition that, in the investigator\'s opinion, would make it unsafe or difficult for the participant to complete the study