Adjuvant transcranial direct current stimulation in patients with chronic migraine: protocol of a randomized controlled trial

Morosoli, Tanya; Amaro, Silvia; Balmagambetova, Saule; Brandão, Renata A.F.S.; Coutinho, Livia; Duarte, Natália de Almeida Carvalho; Gaspar, Rodrigo S.; Klaus, Pascal; Matsuno, Alessandra Kimie; Monroy, Diego L. Pérez; Pintucci, Marco; Prado, Lukas K.P.; Rumiato, Anne Cristine; Sadovsky, Ana Daniela Izoton de; Tafelski, Sascha

doi:10.5455/jcme.20150331115109

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“…Before each local anesthetic infiltration series, a 20 min tDCS stimulation was performed using the NeuroConn DC Stimulator R with saline soaked, square sponge electrodes (surface 25cm 2 ) similar to Nitsche and Paulus et al (22,47,48) (see Supplementary Figure 1). Following the protocol of Morosoli et al, we placed the anode electrode over the primary motor cortex (M1) contralateral to the most predominant painful side, and the cathode electrode over the contralateral supraorbital area (51). The primary motor cortex is located in the Brodman location 4 (52,53).…”

Section: Tdcsmentioning

confidence: 99%

Supplementing transcranial direct current stimulation to local infiltration series for refractory neuropathic craniocephalic pain: A randomized controlled pilot trial

et al. 2023

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BackgroundSome patients with neuralgia of cranial nerves with otherwise therapy-refractory pain respond to invasive therapy with local anesthetics. Unfortunately, pain regularly relapses despite multimodal pain management. Transcranial direct current stimulation (tDCS) may prolong pain response due to neuro-modulatory effects.MethodsThis controlled clinical pilot trial randomized patients to receive anodal, cathodal or sham-tDCS stimulation prior to local anesthetic infiltration. Pain attenuation, quality-of-life and side effects were assessed and compared with historic controls to estimate effects of tDCS stimulation setting.ResultsAltogether, 17 patients were randomized into three groups with different stimulation protocols. Relative reduction of pain intensity in per protocol treated patients were median 73%, 50% and 69% in anodal, cathodal and sham group, respectively (p = 0.726). Compared with a historic control group, a lower rate of responders with 50% reduction of pain intensity indicates probable placebo effects (OR 3.41 stimulation vs. non-stimulation setting, NNT 3.63). 76.9% (n = 10) of tDCS patients reported mild side-effects. Of all initially included 17 patients, 23.5% (n = 4) withdrew their study participation with highest proportion in the cathodal group (n = 3). A sample size calculation for a confirmatory trial revealed 120 patients using conservative estimations.DiscussionThis pilot trial does not support series of anodal tDCS as neuro-modulatory treatment to enhance pain alleviation of local anesthetic infiltration series. Notably, results may indicate placebo effects of tDCS settings. Feasibility of studies in this population was limited due to relevant drop-out rates. Anodal tDCS warrants further confirmation as neuro-modulatory pain treatment option.

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Section: Tdcsmentioning

confidence: 99%