Effect of transspinal direct current stimulation on afferent pain signalling in humans

Thordstein, Magnus; Svantesson, Mats; Rahin, Hedayat

doi:10.1016/j.jocn.2020.04.116

Cited by 10 publications

(20 citation statements)

References 29 publications

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“…This study replicated the findings from numerous previous investigations [8,9], i.e., we found large interindividual variability regarding the effect of neuromodulation. In our opinion, there are two aspects that need to be considered to overcome this obstacle to the introduction of neuromodulation into clinical practice.…”

Section: Discussionsupporting

confidence: 92%

“…Another question that needs to be considered is the dosing of the treatment. Early studies demonstrated short-lasting modulating effects from a single stimulation [6,7,9], and only recently, repeated sessions during a week were shown to produce a more long-lasting effect [8]. Our results demonstrate that for 30-35% of these patients, one stimulation with tsDCS every other day during five days, is well tolerated and produces clinically relevant effects for up to one week.…”

Section: Discussionmentioning

confidence: 51%

“…The technique involves a low-intensity spinal stimulation and has been demonstrated to induce polarity-dependent effects on different pathways of the spinal cord, e.g., [6][7][8]. One promising effect is that of anodal tsDCS on pain signaling; in a double-blind, sham-controlled study on healthy subjects we have been able to reproduce and expand on prior studies [6,7] finding parallel inhibitory effects of anodal tsDCS on subjective pain experience and pain signaling [9].…”

Section: Introductionmentioning

confidence: 66%

“…The exact mechanism of tsDCS remains to be clarified. However, it is apparent that the effects on the spinal cord are polarity dependent, and anodal stimulation has been shown to inhibit nociceptive responses [6][7][8][9]. Effects have been shown to occur on both spinal and supraspinal levels [21,23], affecting nerve fiber excitability and synaptic transmission [23].…”

Section: Discussionmentioning

confidence: 99%

“…A major obstacle for neuromodulation techniques is the large interindividual variation regarding stimulation effects [6][7][8][9]. This necessitates that evaluation of treatments is made not only at the group, but also at the individual level.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Effect of Transcutaneous Spinal Direct Current Stimulation in Patients with Painful Polyneuropathy and Influence of Possible Predictors of Efficacy including BDNF Polymorphism: A Randomized, Sham-Controlled Crossover Study

2023

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Introduction: The neuromodulating effects of transcutaneous-spinal Direct Current Stimulation (tsDCS) have been reported to block pain signaling. For patients with chronic pain, tsDCS could be a potential treatment option. To approach this, we studied the effect of anodal tsDCS on patients with neuropathic pain approaching an optimal paradigm including the investigation of different outcome predictors. Methods: In this randomized, double-blinded, sham-controlled crossover study we recruited twenty patients with neurophysiologically evaluated neuropathic pain due to polyneuropathy (PNP). Variables (VAS; pain and sleep quality) were reported daily, one week prior to, and one week after the stimulation/sham period. Anodal tsDCS (2.5 mA, 20 min) was given once daily for three days during one week. BDNF-polymorphism, pharmacological treatment, and body mass index (BMI) of all the patients were investigated. Results: Comparing the effects of sham and real stimulation at the group level, there was a tendency towards reduced pain, but no significant effects were found. However, for sleep quality a significant improvement was seen. At the individual level, 30 and 35% of the subjects had a clinically significant improvement of pain level and sleep quality, respectively, the first day after the stimulation. Both effects were reduced over the coming week and these changes were negatively correlated. The BDNF polymorphism Val66Met was carried by 35% of the patients and this group was found to have a lower general level of pain but there was no significant difference in the tsDCS response effect. Neither pharmacologic treatment or BMI influenced the treatment effect. Conclusions: Short-term and sparse anodal thoracic tsDCS reduces pain and improves sleep with large inter-individual differences. Roughly 30% will benefit in a clinically meaningful way. The BDNF genotype seems to influence the level of pain that PNP produces. Individualized and intensified tsDCS may be a treatment option for neuropathic pain due to PNP.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 51%

Section: Introductionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Effect of Transcutaneous Spinal Direct Current Stimulation in Patients with Painful Polyneuropathy and Influence of Possible Predictors of Efficacy including BDNF Polymorphism: A Randomized, Sham-Controlled Crossover Study

2023

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Effect of non-invasive spinal cord stimulation in unmedicated adults with major depressive disorder: a pilot randomized controlled trial and induced current flow pattern

Romo-Nava,

Awosika,

Basu

et al. 2023

Mol Psychiatry

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Converging theoretical frameworks suggest a role and a therapeutic potential for spinal interoceptive pathways in major depressive disorder (MDD). Here, we aimed to evaluate the antidepressant effects and tolerability of transcutaneous spinal direct current stimulation (tsDCS) in MDD. This was a double-blind, randomized, sham-controlled, parallel group, pilot clinical trial in unmedicated adults with moderate MDD. Twenty participants were randomly allocated (1:1 ratio) to receive “active” 2.5 mA or “sham” anodal tsDCS sessions with a thoracic (anode; T10)/right shoulder (cathode) electrode montage 3 times/week for 8 weeks. Change in depression severity (MADRS) scores (prespecified primary outcome) and secondary clinical outcomes were analyzed with ANOVA models. An E-Field model was generated using the active tsDCS parameters. Compared to sham (n = 9), the active tsDCS group (n = 10) showed a greater baseline to endpoint decrease in MADRS score with a large effect size (−14.6 ± 2.5 vs. −21.7 ± 2.3, p = 0.040, d = 0.86). Additionally, compared to sham, active tsDCS induced a greater decrease in MADRS “reported sadness” item (−1.8 ± 0.4 vs. −3.2 ± 0.4, p = 0.012), and a greater cumulative decrease in pre/post tsDCS session diastolic blood pressure change from baseline to endpoint (group difference: 7.9 ± 3.7 mmHg, p = 0.039). Statistical trends in the same direction were observed for MADRS “pessimistic thoughts” item and week-8 CGI-I scores. No group differences were observed in adverse events (AEs) and no serious AEs occurred. The current flow simulation showed electric field at strength within the neuromodulation range (max. ~0.45 V/m) reaching the thoracic spinal gray matter. The results from this pilot study suggest that tsDCS is feasible, well-tolerated, and shows therapeutic potential in MDD. This work also provides the initial framework for the cautious exploration of non-invasive spinal cord neuromodulation in the context of mental health research and therapeutics. The underlying mechanisms warrant further investigation. Clinicaltrials.gov registration: NCT03433339 URL: https://clinicaltrials.gov/ct2/show/NCT03433339.

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Anodal transcutaneous spinal direct current stimulation influences the amplitude of pain-related evoked potentials in healthy subjects

Eberhardt,

Enax-Krumova,

Tegenthoff

et al. 2023

Sci Rep

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It has already been described that transcutaneous spinal direct current stimulation (tsDCS) can selectively influence nociceptive evoked potentials. This study is the first aiming to prove an influence of tsDCS on pain-related evoked potentials (PREP) using concentric surface electrodes (CE), whose nociceptive specificity is still under discussion. 28 healthy subjects participated in this sham-controlled, double-blind cross-over study. All subjects underwent one session of anodal and one session of sham low-thoracic tsDCS. Before and after the intervention, PREP using CE, PREP-induced pain perception and somatosensory evoked potentials (SEP) were assessed on the right upper and lower limb. We found a decrease in PREP amplitude at the lower limb after sham stimulation, but not after anodal tsDCS, while SEP remained unchanged under all studied conditions. There was no difference between the effects of anodal tsDCS and sham stimulation on the studied parameters assessed at the upper limb. PREP-induced pain of the upper and lower limb increased after anodal tsDCS. The ability of influencing PREP using a CE at the spinal level in contrast to SEP suggests that PREP using CE follows the spinothalamic pathway and supports the assumption that it is specifically nociceptive. However, while mainly inhibitory effects on nociceptive stimuli have already been described, our results rather suggest that anodal tsDCS has a sensitizing effect. This may indicate that the mechanisms underlying the elicitation of PREP with CE are not the same as for the other nociceptive evoked potentials. The effects on the processing of different types of painful stimuli should be directly compared in future studies.

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Effect of transspinal direct current stimulation on afferent pain signalling in humans

Abstract: Thoracic transspinal Direct Current Stimulation (tsDCS) delay afferent pain signalling.In parallel, subjective experience of pain decreased. Effects increased after stimulation; tsDCS might be a treatment of peripheral pain.

Cited by 10 publications

References 29 publications

Effect of Transcutaneous Spinal Direct Current Stimulation in Patients with Painful Polyneuropathy and Influence of Possible Predictors of Efficacy including BDNF Polymorphism: A Randomized, Sham-Controlled Crossover Study

Effect of Transcutaneous Spinal Direct Current Stimulation in Patients with Painful Polyneuropathy and Influence of Possible Predictors of Efficacy including BDNF Polymorphism: A Randomized, Sham-Controlled Crossover Study

Effect of non-invasive spinal cord stimulation in unmedicated adults with major depressive disorder: a pilot randomized controlled trial and induced current flow pattern

Anodal transcutaneous spinal direct current stimulation influences the amplitude of pain-related evoked potentials in healthy subjects

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