Assessment and treatment of pain with non-invasive cortical stimulation

Zaghi, Soroush; Thiele, Bruna; Pimentel, Daniel C.; Pimentel, Thaís; Fregni, Felipe

doi:10.3233/rnn-2011-0615

Cited by 39 publications

(37 citation statements)

References 62 publications

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“…In patients undergoing the total knee arthroplasty, tDCS reduces opioid consumption and pain level (70). For treating chronic pain regardless of etiology, the ES of tDCS has been estimated between −2.29 (95% CI= −3.5 to −1.08) (71) and −0.86 (95% C.I., −1.54, −0.19) (72). Although a pre-specified subgroup analysis in meta-analysis with distinct types of chronic pain indicated that tDCS was superior than sham (ES −0.59, 95% CI −1.10 to −0.08) (29) a further meta-analysis failed to detect a superiority of tDCS over sham in reducing pain (73), possibly due to heterogeneity.…”

Section: Efficacymentioning

confidence: 99%

Regulatory considerations for the clinical and research use of transcranial direct current stimulation (tDCS): Review and recommendations from an expert panel

Fregni

Nitsche

Loo

et al. 2014

Clinical Research and Regulatory Affairs

229

161

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The field of transcranial electrical stimulation (tES) has experienced significant growth in the past 15 years. One of the tES techniques leading this increased interest is transcranial direct current stimulation (tDCS). Significant research efforts have been devoted to determining the clinical potential of tDCS in humans. Despite the promising results obtained with tDCS in basic and clinical neuroscience, further progress has been impeded by a lack of clarity on international regulatory pathways. We therefore convened a group of research and clinician experts on tDCS to review the research and clinical use of tDCS. In this report, we review the regulatory status of tDCS, and we summarize the results according to research, off-label and compassionate use of tDCS in the following countries: Australia, Brazil, France, Germany, India, Iran, Italy, Portugal, South Korea, Taiwan and United States. Research use, off label treatment and compassionate use of tDCS are employed in most of the countries reviewed in this study. It is critical that a global or local effort is organized to pursue definite evidence to either approve and regulate or restrict the use of tDCS in clinical practice on the basis of adequate randomized controlled treatment trials.

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Section: Efficacymentioning

confidence: 99%

Regulatory considerations for the clinical and research use of transcranial direct current stimulation (tDCS): Review and recommendations from an expert panel

Fregni

Nitsche

Loo

et al. 2014

Clinical Research and Regulatory Affairs

229

161

View full text Add to dashboard Cite

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“…Furthermore, the centered location of M1 between the anodes and cathodes facilitated the postero-anterior stimulation of the precentral gyrus’ superficial fibers, tangential to the surface. These parameters of current distribution in M1 are sought by other non-invasive and invasive neuromodulatory techniques to produce optimal pain relief, including transcranial magnetic stimulation (TMS) and MCS, respectively [34]. …”

Section: Discussionmentioning

confidence: 99%

High-Definition and Non-invasive Brain Modulation of Pain and Motor Dysfunction in Chronic TMD

et al. 2015

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Background Temporomandibular disorders (TMD) have a relatively high prevalence and in many patients pain and masticatory dysfunction persist despite a range of treatments. Non-invasive brain neuromodulatory methods, namely transcranial direct current stimulation (tDCS), can provide relatively long-lasting pain relief in chronic pain patients. Objective To define the neuromodulatory effect of five daily 2×2 motor cortex high-definition tDCS (HD-tDCS) sessions on clinical pain and motor measures in chronic TMD patients. It is predicted that M1 HD-tDCS will selectively modulate clinical measures, by showing greater analgesic after-effects compared to placebo, and active treatment will increase pain free jaw movement more than placebo. Methods Twenty-four females with chronic myofascial TMD pain underwent five daily, 20-minute sessions of active or sham 2 milliamps (mA) HD-tDCS. Measurable outcomes included pain-free mouth opening, visual analog scale (VAS), sectional sensory-discriminative pain measures tracked by a mobile application, short form of the McGill Pain Questionnaire, and the Positive and Negative Affect Schedule. Follow-up occurred at one-week and four-weeks post treatment. Results There were significant improvements for clinical pain and motor measurements in the active HD-tDCS group compared to the placebo group for: responders with pain relief above 50% in the VAS at four-week follow-up (p=0.04); pain-free mouth opening at one-week follow-up (p<0.01); and sectional pain area, intensity and their sum measures contralateral to putative M1 stimulation during the treatment week (p<0.01). No changes in emotional values were shown between groups. Conclusion Putative M1 stimulation by HD-tDCS selectively improved meaningful clinical sensory-discriminative pain and motor measures during stimulation, and up to four weeks post-treatment in chronic myofascial TMD pain patients.

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“…The active electrode (anode) was placed over M1 contralateral to the side of the worst knee and the reference electrode (cathode) over the contralateral supraorbital region [26]. The primary motor cortex has emerged as one of the most effective and reliable sites for tDCS in the treatment of pain, producing improvements in pain analogous to those of FDA approved pharmaceuticals in other musculoskeletal pain conditions with considerably fewer side-effects [27].…”

Section: Participants and Methodsmentioning

confidence: 99%

Addition of transcranial direct current stimulation to quadriceps strengthening exercise in knee osteoarthritis: A pilot randomised controlled trial

et al. 2017

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A randomised, assessor- and participant-blind, sham-controlled trial was conducted to assess the safety and feasibility of adding transcranial direct current stimulation (tDCS) to quadriceps strengthening exercise in knee osteoarthritis (OA), and provide data to inform a fully powered trial. Participants were randomised to receive active tDCS+exercise (AT+EX) or sham tDCS+exercise (ST+EX) twice weekly for 8 weeks whilst completing home exercises twice per week. Feasibility, safety, patient-perceived response, pain, function, pressure pain thresholds (PPTs) and conditioned pain modulation (CPM) were assessed before and after treatment. Fifty-seven people were screened for eligibility. Thirty (52%) entered randomisation and 25 (84%) completed the trial. One episode of headache in the AT+EX group was reported. Pain reduced in both groups following treatment (AT+EX: p<0.001, partial η2 = 0.55; ST+EX: p = 0.026, partial η2 = 0.18) but no between-group differences were observed (p = 0.18, partial η2 = 0.08). Function improved in the AT+EX (p = 0.01, partial η2 = 0.22), but not the ST+EX (p = 0.16, partial η2 = 0.08) group, between-group differences did not reach significance (p = 0.28, partial η2 = 0.052). AT+EX produced greater improvements in PPTs than ST+EX (p<0.05) (superolateral knee: partial η2 = 0.17; superior knee: partial η2 = 0.3; superomedial knee: partial η2 = 0.26). CPM only improved in the AT+EX group but no between-group difference was observed (p = 0.054, partial η2 = 0.158). This study provides the first feasibility and safety data for the addition of tDCS to quadriceps strengthening exercise in knee OA. Our data suggest AT+EX may improve pain, function and pain mechanisms beyond that of ST+EX, and provides support for progression to a fully powered randomised controlled trial.

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Assessment and treatment of pain with non-invasive cortical stimulation

Cited by 39 publications

References 62 publications

Regulatory considerations for the clinical and research use of transcranial direct current stimulation (tDCS): Review and recommendations from an expert panel

Regulatory considerations for the clinical and research use of transcranial direct current stimulation (tDCS): Review and recommendations from an expert panel

High-Definition and Non-invasive Brain Modulation of Pain and Motor Dysfunction in Chronic TMD

Addition of transcranial direct current stimulation to quadriceps strengthening exercise in knee osteoarthritis: A pilot randomised controlled trial

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