Transcranial direct current stimulation in fibromyalgia: effects on pain and quality of life evaluated clinically and by brain perfusion scintigraphy

Abstract

BACKGROUND AND OBJECTIVES: Transcranial Direct Current Stimulation is a neuromodulation method to treat neuropsychiatric and other diseases. This study aimed at evaluating the effect of this technique on pain and quality of life of fibromyalgia patients, in addition to studying brain images by Brain Perfusion Scintigraphy before and after procedures. METHODS: Prospective, double-blind, randomized, controlled study with parallel arms evaluated clinically and by CT scan with single photon emission (Brain Spect). Sample was made up of 20 female fibromyalgia patients divided in two groups of 10. Parameters evaluated were quality of life by the pain Visual Analog Scale, Quality of Life Questionnaire SF-36, Fibromyalgia Impact Questionnaire and pain level measurement on tender points with Fischer's Algiometer. The effective group has received 1.0mA anodal stimulation for 20 minutes in M1 to the left, cathode positioned on the right supraorbital region once a week in a total of 10 consecutive weeks. The Sham group received no electric impulses. RESULTS: There has been decrease in the Fibromyalgia Impact Questionnaire (55.36 to 35.42; p=0.0059) and the Visual Analog Scale (6.05 to 3.60; p=0.0316) scores. There has been statistically significant difference (p<0.05) in trigger points measurement in the effective group. For the effective group, the-Transcranial direct current stimulation in fibromyalgia: effects on pain and quality of life evaluated clinically and by brain perfusion scintigraphy* Estimulação elétrica transcraniana por corrente contínua em fibromialgia: efeitos sobre a dor e a qualidade de vida, avaliados clinicamente e por cintilografia de perfusão cerebral

Transcranial direct current stimulation for upper limb neuropathic pain: A double‐blind randomized controlled trial

“…We used 1 mA to facilitate blinding of the participants as the efficacy of blinding with intensities higher than this is uncertain (Riberto et al., ; Kessler et al., ; O'Connell et al., ; Palm et al., ); however, this may have limited the physiological impact of active tDCS. Other studies using 1 mA intensity have reported a significant reduction in pain (Fenton et al., ; Antal et al., ; Sakrajai et al., ; Jales Junior et al., ), and there were individuals within our active group who had a sustained and clinically meaningful reduction in pain. Another limitation of our study may be the heterogeneity of the participants, who presented with a variety of aetiologies underlying their neuropathic pain, and the potential for differences in medication use between groups to influence the outcomes.…”

Non-invasive brain stimulation techniques for chronic pain

“…We included 38 new studies in this review. Of these, 12 studies (355 participants) investigated only rTMS (Boyer 2014; Dall'Agnol 2014; de Oliveira 2014; Jetté 2013; Malavera 2013; Medeiros 2016; Nardone 2017; Nurmikko 2016; Tekin 2014; Umezaki 2016; Yagci 2014; Yilmaz 2014), 22 studies (772 participants) investigated tDCS (Ahn 2017; Ayache 2016; Bae 2014; Brietzke 2016; Chang 2017; Donnell 2015; Fagerlund 2015; Hagenacker 2014; Harvey 2017; Hazime 2017; Jales Junior 2015; Khedr 2017; Kim 2013; Lagueux 2017; Luedtke 2015; Mendonca 2016; Ngernyam 2015; Oliveira 2015; Sakrajai 2014; Souto 2014; Thibaut 2017; Volz 2016) one study (36 participants) investigated tDCS and rTMS (Attal 2016), two studies (16 participants) investigated tRNS (Curatolo 2017; Palm 2016) and one study investigated RINCE (Deering 2017, 46 participants). Overall this updated review included 94 studies (2983 participants), with 42 trials of rTMS (1101 participants), 36 trials of tDCS (1073 participants), 11 studies of CES (572 participants), one study (36 participants) of both rTMS and tDCS, two studies of RINCE (137 participants) and two studies of tRNS (36 participants).…”

“…For CES there were eight parallel studies (Gabis 2003; Gabis 2009; Katsnelson 2004; Lichtbroun 2001; Rintala 2010; Tan 2006; Tan 2011; Taylor 2013), and three cross‐over studies (Capel 2003; Cork 2004; Tan 2000), of which we considered two as parallel studies, with only the opening phase of the study considered in this review because subsequent phases were unblinded (Capel 2003; Cork 2004). For tDCS there were 26 parallel studies (Ahn 2017; Bae 2014; Brietzke 2016; Chang 2017; Donnell 2015; Fagerlund 2015; Fregni 2006a; Fregni 2006b; Harvey 2017; Hazime 2017; Jales Junior 2015; Khedr 2017; Lagueux 2017; Kim 2013; Luedtke 2015; Mendonca 2011; Mendonca 2016; Mori 2010; Oliveira 2015; Riberto 2011; Sakrajai 2014; Soler 2010; Souto 2014; Thibaut 2017; Valle 2009; Volz 2016), and 10 cross‐over studies (Antal 2010; Ayache 2016; Boggio 2009; Fenton 2009; Hagenacker 2014; Jensen 2013; Ngernyam 2015; Portilla 2013; Villamar 2013; Wrigley 2014), of which we considered one as a parallel study with only the opening phase of the study considered in this review due to excessive attrition after the first phase (Antal 2010). One study of tRNS (Palm 2016) used a cross‐over design and one a parallel design (Curatolo 2017) and both RINCE studies used a parallel design (Deering 2017; Hargr...…”

“…Of the studies of tDCS one study included participants with a mixture of central, peripheral and facial neuropathic pain (Boggio 2009), two studies included participants with neuropathic pain secondary to multiple sclerosis (Ayache 2016; Mori 2010), five included participants with central neuropathic pain following spinal cord injury (Fregni 2006a; Ngernyam 2015; Soler 2010; Thibaut 2017; Wrigley 2014), one with central poststroke pain (Bae 2014), one with neuropathic or non‐neuropathic pain following spinal cord injury (Jensen 2013), one with trigeminal neuralgia (Hagenacker 2014) and one with painful diabetic polyneuropathy (Kim 2013). Twenty studies included non‐neuropathic pain, specifically chronic pelvic pain (Fenton 2009), osteoarthritis (OA) of the knee (Ahn 2017; Chang 2017), fibromyalgia (Fagerlund 2015; Fregni 2006b; Jales Junior 2015; Khedr 2017; Mendonca 2011; Mendonca 2016; Riberto 2011; Villamar 2013), temporomandibular joint pain (Donnell 2015; Oliveira 2015), hepatitis C‐related chronic pain (Brietzke 2016), human T‐lymphotropic virus 1 (HTLV‐1) and viral hepatitis‐related chronic back or leg pain (Souto 2014), chronic nonspecific low back pain (Hazime 2017; Luedtke 2015), inflammatory bowel disease‐related pain (Volz 2016) or a mixed pain group (Antal 2010; Harvey 2017). One study included participants with neuropathic pain following burn injury (Portilla 2013) and one included participants with CRPS1 (Lagueux 2017).…”

“…Most studies included both male and female participants except Fenton 2009 (chronic pelvic pain), Dall'Agnol 2014, Medeiros 2016 (chronic myofascial pain), Donnell 2015 (temporomandibular disorder), Curatolo 2017; Fregni 2006b; Jales Junior 2015; Lee 2012; Mhalla 2011; Riberto 2011; Valle 2009; Yagci 2014 (fibromyalgia) which recruited women only and Yilmaz 2014 (post‐spinal cord injury pain), which recruited only men. Three studies did not present data on gender distribution (Capel 2003; Fregni 2005; Katsnelson 2004).…”