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

Abstract

Introduction: Transcranial Direct Current Stimulation (tDCS) is a non-invasive neuromodulation technique which has been widely studied for the treatment of chronic pain. It is considered a promising and safe alternative pain therapy. Different targets have been tested, each having their own particular mechanisms for modulating pain perception. Areas covered:We discuss the current state of the art of tDCS to manage pain and future strategies to optimize tDCS' effects. Current strategies include primary motor cortex tDCS, prefrontal tDCS and tDCS combined with behavioral interventions while future strategies, on the other hand, include high intensity tDCS, transcutaneous Spinal Direct Current Stimulation, cerebellar tDCS, home-based tDCS and tDCS with extended number of sessions.Expert commentary: It has been shown that the stimulation of the prefrontal and primary motor cortex is efficient for pain reduction while a few other new strategies, such as high intensity tDCS and network-based tDCS, are believed to induce strong neuroplastic effects, although the underlying neural mechanisms still need to be fully uncovered. Hence, conventional tDCS approaches demonstrated promising effects to manage pain and new strategies are under development to enhance tDCS effects and make this approach more easily available by using, for instance, home-based devices.

Transcranial Direct Current Stimulation (tDCS) Combined with Therapeutic Exercise and Cognitive Rehabilitation to Treat a Case of Burning Mouth Syndrome (BMS) Related Pain

“…Nevertheless, our evaluation of the psychophysical results supports the hypothesis that chronic pain conditions maladaptive neuroplasticity, producing an imbalance in the allocation of attentional and cognitive resources and resulting in a misperception of pain [42]. Thus, behavioral therapies combined with non-invasive neuromodulation and therapeutical exercise may be effective in reducing pain perception and should be further encouraged [43].…”

Active and sham transcranial direct current stimulation (tDCS) improved quality of life in female patients with fibromyalgia

“…Moreover, the DLPFC is an important area involved in the cognitive processing of pain [28,[69][70][71]. tDCS over the left DLPFC has been associated with control of cognitive aspects of pain in patients with FM [72]. However, we hypothesized that stimulation over a specific area related to pain that presumably plays a crucial role in FM [73][74][75], such as the operculo-insular cortex (OIC), would be more effective than stimulation of the traditional and less specific targets (M1 and DLPFC).…”

Effects of Transcutaneous Spinal Direct Current Stimulation (tsDCS) in Patients With Chronic Pain: A Clinical and Neurophysiological Study

“…This could be explained by different factors, such as the small sample size, the short duration of the stimulation protocol (5 days), or the heterogeneity of pain etiologies. Indeed, the need of a protocol optimization to identify the most effective tsDCS stimulation scheme for chronic pain ( 58 ) has been reported, considering also the different degrees of central sensitization ( 59 ) involved in such condition.…”