Noninvasive brain stimulation combined with exercise in chronic pain: a systematic review and meta-analysis

Cardenas-Rojas, Alejandra; Pacheco‐Barrios, Kevin; Giannoni‐Luza, Stefano; Rivera-Torrejón, Oscar; Fregni, Felipe

doi:10.1080/14737175.2020.1738927

Cited by 41 publications

(34 citation statements)

References 58 publications

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“…Immediately after sham or active tDCS, 20 patients performed a standardized 30minute set of quadriceps strengthening exercises for 8 weeks, as to analyse whether tDCS enhances the effects of physical exercise or not for this specific population obtaining decrease of pain and improving physical function [134,135]. In a recent metanalysis, a moderate effect size was found in the combination of tDCS and exercise for chronic pain compare to tDCS alone [136]. Another approach is the synergistic effect of meditation and tDCS.…”

Section: Tdcs Combined With Behavioural Interventionsmentioning

confidence: 99%

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

Pacheco‐Barrios¹,

Cardenas-Rojas

Thibaut

et al. 2020

Expert Review of Medical Devices

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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.

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Section: Tdcs Combined With Behavioural Interventionsmentioning

confidence: 99%

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

Pacheco‐Barrios¹,

Cardenas-Rojas

Thibaut

et al. 2020

Expert Review of Medical Devices

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“…However, a systematic review of 12 randomized clinical trials involving 350 patients with focal or generalized chronic pain found that low‐frequency rTMS stimulation produced no effect, whereas high‐frequency stimulation induced long‐lasting analgesic effect and meaningful relief from chronic pain 48 . Similarly, other systematic reviews and meta‐analysis have identified that rTMS 49,50 as well as rTMS combined with exercise 51 has beneficial effect on relieving patients from chronic pain.…”

Section: Non‐invasive Brain Stimulationmentioning

confidence: 99%

Brain stimulation: a therapeutic approach for the treatment of neurological disorders

et al. 2021

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Brain stimulation has become one of the most acceptable therapeutic approaches in recent years and a powerful tool in the remedy against neurological diseases. Brain stimulation is achieved through the application of electric currents using non‐invasive as well as invasive techniques. Recent technological advancements have evolved into the development of precise devices with capacity to produce well‐controlled and effective brain stimulation. Currently, most used non‐invasive techniques are repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), whereas the most common invasive technique is deep brain stimulation (DBS). In last decade, application of these brain stimulation techniques has not only exploded but also expanded to wide variety of neurological disorders. Therefore, in the current review, we will provide an overview of the potential of both non‐invasive (rTMS and tDCS) and invasive (DBS) brain stimulation techniques in the treatment of such brain diseases.

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“…Since tDCS is a neuromodulatory (only changes the likelihood of spontaneous neuronal firing), its optimal effect is achieved when combined with a behavioral intervention. 15…”

Section: Introductionmentioning

confidence: 99%

“…Since tDCS is a neuromodulatory (only changes the likelihood of spontaneous neuronal firing), its optimal effect is achieved when combined with a behavioral intervention. 15 To address this gap in PLP treatment, we aimed to test whether tDCS combined with MT has a greater impact on PLP than any therapy alone in traumatic lower limb amputees. Second, we tested the effects of these interventions on motor cortex plasticity, by assessing cortical excitability and cortical mapping changes before and after treatment using transcranial magnetic stimulation (TMS).…”

Section: Introductionmentioning

confidence: 99%

Effects of Combined and Alone Transcranial Motor Cortex Stimulation and Mirror Therapy in Phantom Limb Pain: A Randomized Factorial Trial

Gunduz

Pacheco‐Barrios

Pinto

et al. 2021

Neurorehabil Neural Repair

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Phantom limb pain (PLP) is a frequent complication in amputees, which is often refractory to treatments. We aim to assess in a factorial trial the effects of transcranial direct current stimulation (tDCS) and mirror therapy (MT) in patients with traumatic lower limb amputation; and whether the motor cortex plasticity changes drive these results. In this large randomized, blinded, 2-site, sham-controlled, 2 × 2 factorial trial, 112 participants with traumatic lower limb amputation were randomized into treatment groups. The interventions were active or covered MT for 4 weeks (20 sessions, 15 minutes each) combined with 2 weeks of either active or sham tDCS (10 sessions, 20 minutes each) applied to the contralateral primary motor cortex. The primary outcome was PLP changes on the visual analogue scale at the end of interventions (4 weeks). Motor cortex excitability and cortical mapping were assessed by transcranial magnetic stimulation (TMS). We found no interaction between tDCS and MT groups ( F = 1.90, P = .13). In the adjusted models, there was a main effect of active tDCS compared to sham tDCS (beta coefficient = −0.99, P = .04) on phantom pain. The overall effect size was 1.19 (95% confidence interval: 0.90, 1.47). No changes in depression and anxiety were found. TDCS intervention was associated with increased intracortical inhibition (coefficient = 0.96, P = .02) and facilitation (coefficient = 2.03, P = .03) as well as a posterolateral shift of the center of gravity in the affected hemisphere. MT induced no motor cortex plasticity changes assessed by TMS. These findings indicate that transcranial motor cortex stimulation might be an affordable and beneficial PLP treatment modality.

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Noninvasive brain stimulation combined with exercise in chronic pain: a systematic review and meta-analysis

Cited by 41 publications

References 58 publications

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

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

Brain stimulation: a therapeutic approach for the treatment of neurological disorders

Effects of Combined and Alone Transcranial Motor Cortex Stimulation and Mirror Therapy in Phantom Limb Pain: A Randomized Factorial Trial

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