A randomized, sham‐controlled, proof of principle study of transcranial direct current stimulation for the treatment of pain in fibromyalgia

Abstract

Objective. Recent evidence suggests that fibromyalgia is a disorder characterized by dysfunctional brain activity. Because transcranial direct current stimulation (tDCS) can modulate brain activity noninvasively and can decrease pain in patients with refractory central pain, we hypothesized that tDCS treatment would result in pain relief in patients with fibromyalgia.Methods. Thirty-two patients were randomized to receive sham stimulation or real tDCS with the anode centered over the primary motor cortex (M1) or the dorsolateral prefrontal cortex (DLPFC) (2 mA for 20 minutes on 5 consecutive days). A blinded evaluator rated the patient's pain, using the visual analog scale for pain, the clinician's global impression, the patient's global assessment, and the number of tender points. Other symptoms of fibromyalgia were evaluated using the Fibromyalgia Impact Questionnaire and the Short Form 36 Health Survey. Safety was assessed with a battery of neuropsychological tests. To assess potential confounders, we measured mood and anxiety changes throughout the trial.Results. Anodal tDCS of the primary motor cortex induced significantly greater pain improvement compared with sham stimulation and stimulation of the DLPFC (P < 0.0001). Although this effect decreased after treatment ended, it was still significant after 3 weeks of followup (P ‫؍‬ 0.004). A small positive impact on quality of life was observed among patients who received anodal M1 stimulation. This treatment was associated with a few mild adverse events, but the frequency of these events in the active-treatment groups was similar to that in the sham group. Cognitive changes were similar in all 3 treatment groups. Conclusion. Our findings provide initial evidence of a beneficial effect of tDCS in fibromyalgia, thus encouraging further trials.Recent evidence has shown that fibromyalgia is associated with specific changes in brain activity. In a recent single-photon-emission computed tomography study, patients with fibromyalgia (as compared with healthy controls) showed a decrease in regional cerebral blood flow in the thalamus, caudate nucleus, and pontine tegmentum (1). In addition, it has long been demonstrated that antidepressants, such as tricyclic agents, improve pain in fibromyalgia (2), and recent studies suggest that centrally acting drugs such as dopaminergic drugs are effective in alleviating the symptoms of fibromyalgia, as compared with placebo (3).In this context of brain dysfunction, techniques for neuromodulation could be a beneficial approach for this group of patients. In fact, results of several studies have shown that motor cortex stimulation with epidural electrodes or with repetitive transcranial magnetic stimDr. Fregni

Measurements and models of electric fields in the in vivo human brain during transcranial electric stimulation

“…More recently weak alternating currents (tACS) have also been used in an effort to entrain or modulate brain activity (Herrmann et al, 2013;Reato et al, 2013;Ali et al, 2013;Alekseichuk et al, 2016;Lustenberger et al, 2016). Because of their simplicity, flexibility and safety profile, these techniques have been investigated in over 70 neuropsychiatric conditions, including major depression , epilepsy (Fregni et al, 2006d;Auvichayapat et al, 2013), tinnitus (Frank et al, 2012), Parkinson's disease (Fregni et al, 2006b), pain control (Fregni et al, 2006a(Fregni et al, , 2006c, and stroke rehabilitation (Schlaug et al, 2008;Baker et al, 2010) among others. In healthy subjects tDCS may benefit declarative memory (Marshall et al, 2004), working memory (Fregni et al, 2005), motor learning (Reis and Fritsch, 2011), verbal fluency (Pereira et al, 2013), and planning ability (Dockery et al, 2009).…”

Cathodal transcranial direct‐current stimulation for treatment of drug‐resistant temporal lobe epilepsy: A pilot randomized controlled trial

“…It has been shown that the induced excitability changes and the length of the lasting effect depend on two parameters of direct currents: intensity and duration of application 26, 27. The effects of modifications of these parameters have been tested in a few clinical applications 28, 29, 30…”

A utilização dos recursos eletrotermofototerapêuticos no tratamento da síndrome da fibromialgia: uma revisão sistemática

“…Studies were also excluded if they involved the use of unconventional hyperthermia treatments 7 ; if they used electroacupuncture, which is not included in most physical therapy curricula 8 ; if they lacked a control group or another form of intervention to compare to the electrothermal and phototherapy group [9][10][11][12] ; and if they lacked a commonly used technique in physical therapy training and practice [13][14][15] .…”

“…This resource acts through neuromodulation, being used by physicians since the 1950's to treat sleep disorders, pain, cognitive deficits, depression, anxiety, among others, and it has been reported as a resource for FMS treatment [13][14][15] . This modality consists of a micro-current that acts at a subliminal level with direct effect on the brain, on the limbic system, on the reticular activating system level and/or the hypothalamus.…”