At-Home Cortical Stimulation for Neuropathic Pain: a Feasibility Study with Initial Clinical Results

Abstract

The clinical use of noninvasive cortical stimulation procedures is hampered by the limited duration of the analgesic effects and the need to perform stimulation in hospital settings. Here, we tested the feasibility and pilot efficacy of an internet-based system for at-home, long-duration, medically controlled transcranial motor cortex stimulation (H-tDCS), via a double-blinded, shamcontrolled trial in patients with neuropathic pain refractory to standard-of-care drug therapy. Each patient was first trained at hospital, received a stimulation kit, allotted a password-protected Web space, and completed daily tDCS sessions during 5 weeks, via a Bluetooth connection between stimulator and a minilaptop. Each session was validated and internet-controlled by hospital personnel. Daily pain ratings were obtained during 11 consecutive weeks, and afterwards via iterative visits/phone contacts. Twenty full procedures were completed in 12 consecutive patients (500 daily tDCS sessions, including 20% sham). No serious adverse effects were recorded. Superficial burning at electrode position occurred in 2 patients, and nausea/headache in two others, all of whom wished to pursue stimulation. Six out of the 12 patients achieved satisfactory relief on a scale combining pain scores, drug intake, and quality of life. Daily pain reports correlated with such combined assessment, and differentiated responders from nonresponders without overlap. Clinical improvement in responders could last up to 6 months. Five patients asked to repeat the whole procedure when pain resumed again, with comparable results. At-home, long-duration tDCS proved safe and technically feasible, and provided long-lasting relief in 50% of a small sample of patients with drug-resistant neuropathic pain.

Methods and strategies of tDCS for the treatment of pain: current status and future directions

“…In a current randomized in parallel double-blinded design, with adults' females with fibromyalgia allocated 2:1 to receive a-tDCS or sham tDCS for four weeks (20 sessions) we found that the adherence verified by the records on the software in the active-tDCS was 91.71% (n=28), while that received sham-tDCS was 98.51%(n=14) [152]. In addition, the studies with tDCS at home have found only minor adverse effects with an incidence comparable to the ones described in the literature when the treatment is applied under direct supervision [23,150,151].…”

“…They rated daily pain daily during 11 consecutive weeks, and afterward via iterative visits/phone contacts. Patients achieved satisfactory relief on a scale combining pain scores, drug intake, and quality of life [150]. In another randomized study, we evaluate the feasibility of tDCS at home for 10 days (10 sessions) in 20 healthy subjects (8 men /12 women).…”

Safety and Feasibility of Tele-Supervised Home-Based Transcranial Direct Current Stimulation for Major Depressive Disorder

“…There has been a growing interest to employ home-based tDCS as an intervention for a wide array of clinical conditions, research so far has been done on conditions ranging from neuropathic pain (Garcia-Larrea et al, 2019) to Multiple Sclerosis (Charvet et al, 2017). The described remote training program could be adapted to clinical contexts beyond depression.…”

Transcranial Direct Current Stimulation for the Management of Neuropathic Pain: A Narrative Review

“…Although active tDCS over the contralateral M1 (1.4 mA, 30 min) was administered for 5 consecutive days, no significant difference was observed between anodal, cathodal, or sham tDCS treatments in 21 patients. Recently, in 2019, Garcia-Larrea et al (3) reported that 6 out of 12 NP patients with various conditions (e.g., CPSP, SCI, or BPI) achieved satisfactory changes in pain intensity. This study demonstrated that 20 sessions of tDCS over the M1 (2 mA, 20 min) were safe and provided long-lasting pain relief.…”

“…patients are non-responsive to conventional analgesics, which include non-steroidal anti-inflammatory drugs, anticonvulsants, or antidepressants. In such cases, neuromodulation treatments such as repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and deep brain stimulation, are applied for the treatment of NP (3).…”