Additive Analgesic Effect of Transcranial Direct Current Stimulation Together with Mirror Therapy for the Treatment of Phantom Pain

Pain Medicine ◽  
2020 ◽  
Author(s):  
Nitza Segal ◽  
Dorit Pud ◽  
Hagai Amir ◽  
Motti Ratmansky ◽  
Pora Kuperman ◽  
...  
Keyword(s):  
Treatment Group ◽  
Pain Intensity ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Analgesic Effect ◽  
Secondary Outcome ◽  
Mcgill Pain Questionnaire ◽  
Phantom Pain ◽  
Mirror Therapy ◽  
Direct Current Stimulation

Abstract Objective Current analgesic treatments for phantom pain are not optimal. One well-accepted yet limited nonpharmacological option is mirror therapy, which is thought to counterbalance abnormal plasticity. Transcranial direct current stimulation (tDCS) is an emerging approach believed to affect the membrane potential and activity threshold of cortical neurons. tDCS analgesic effectiveness, however, is mild and short, rendering it a noneffective stand-alone treatment. This study aimed to assess if a combination of mirror therapy with tDCS results in a superior analgesic effect as compared with mirror therapy alone in patients suffering from phantom pain due to recent amputation. Design Following ethical approval, eligible patients provided informed consent and were randomly assigned to a study treatment group that continued for 2 weeks (once daily): 1) mirror therapy; 2) mirror therapy and sham tDCS; or 3) mirror therapy and tDCS. Assessments were done before treatment; at the end of treatment weeks 1 and 2; and at 1 week, 1 month, and 3 months following treatment. The primary outcome measure was pain intensity. Secondary measures were derived from the Short Form McGill Pain Questionnaire and the Brief Pain Inventory. Results Thirty patients were recruited, and 29 patients completed the study. Three months following treatment, pain intensity was significantly (P<0.001) reduced in the combined treatment group (reduction of 5.4±3.3 points) compared with the other study arms (mirror therapy, 1.2±1.1; mirror therapy and sham tDCS, 2.7±3.2). All secondary outcome results were in line with these findings. Conclusions Combining tDCS with mirror therapy results in a robust long-lasting analgesic effect. These encouraging findings may contribute to the understanding of the underlying mechanisms of phantom pain.

Transcranial direct current stimulation relieves visceral hypersensitivity via normalizing GluN2B expression and neural activity in anterior cingulate corter

2021 ◽  
Author(s):  
Ying Xiao ◽  
Lei Xie ◽  
Qi-Ya Xu ◽  
Li Chen ◽  
Huan Chen ◽  
...  
Keyword(s):  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Analgesic Effect ◽  
Underlying Mechanism ◽  
Pharmacological Therapy ◽  
Visceral Hypersensitivity ◽  
Anterior Cingulate ◽  
Direct Current Stimulation ◽  
Colorectal Distention ◽  
Irritable Bowel

Irritable bowel syndrome (IBS) is one of the most common clinical diseases with treatment for which being challenging. The aim of this study is to investigate whether transcranial direct current stimulation (tDCS) has analgesic effect on visceral hypersensitivity (VH) in an animal model of IBS as well as the underlying mechanism. Since the activation of GluN2B in anterior cingulate cortex (ACC) takes part in VH, we examined whether and how GluN2B in ACC take part in the effect of tDCS. Neonatal maternal deprivation (NMD), a valuable experimental model to study the IBS pathophysiology, was used to induce visceral hypersensitivity of rats. We quantified VH as colorectal distention threshold and performed patch clamp recordings of ACC neurons. The expression of GluN2B were determined by RT-qPCR and western blotting. The GluN2B antagonist Ro 25-6981 was microinjected into the rostral and caudal ACC. tDCS was performed for 7 consecutive days. It was found that NMD decreased expression of GluN2B, which could be obviously reversed by tDCS. Injection of Ro 25-6981 into rostral and caudal ACC of normal rats induced VH and also reversed the analgesic effect of tDCS. Our data sheds light on the non-pharmacological therapy for chronic VH in pathological states such as IBS.

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

2021 ◽  
Vol 24 (6) ◽  
pp. E771-E781
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Neuropathic Pain ◽  
Trigeminal Neuralgia ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Phantom Pain ◽  
Direct Current Stimulation ◽  
Cord Injury

BACKGROUND: Neuropathic pain (NP) is common and often resistant to conventional analgesics. Among different types of noninvasive brain stimulation techniques, transcranial direct current stimulation (tDCS) has been widely used to mitigate pain in patients with NP. OBJECTIVE: The aim of this study was to review the effects of tDCS on the management of various types of NP. STUDY DESIGN: Narrative review. METHODS: A PubMed search was conducted for articles published until October 1, 2020, using tDCS to treat NP. The key search phrase, transcranial direct current stimulation and pain, was used to identify potentially relevant articles. The following inclusion criteria were applied for article selection: (1) studies involving patients with NP and (2) studies that used tDCS to treat NP. Review articles were excluded from the analysis. RESULTS: A total of 524 potentially relevant articles were identified. After reading the titles and abstracts and assessing eligibility based on the full-text articles, 34 publications were included in our review. Overall, our results suggest that tDCS induced pain reduction in patients with NP due to stroke or spinal cord injury, multiple sclerosis, or trigeminal neuralgia. There is insufficient evidence to validate the efficacy of tDCS for treating other painful conditions, such as complex regional pain syndrome, phantom pain, or NP of various origins. LIMITATIONS: The review did not include studies indexed in databases other than PubMed. CONCLUSION: The results of the included studies suggest that tDCS may be beneficial in treating patients with NP due to stroke, spinal cord injury, multiple sclerosis, and trigeminal neuralgia. Further studies are recommended to validate the efficacy of tDCS in treating other types of NPs. KEY WORDS: Transcranial direct current stimulation, neuropathic pain, central post-stroke pain, spinal cord injury, multiple sclerosis, complex regional pain syndrome, phantom pain, trigeminal neuralgia

scholarly journals Transcranial Direct Current Stimulation and Mirror Therapy for Neuropathic Pain After Brachial Plexus Avulsion: A Randomized, Double-Blind, Controlled Pilot Study

2020 ◽  
Vol 11 ◽  
Author(s):  
Clarice Martins Ferreira ◽  
Carolina Dias de Carvalho ◽  
Ruth Gomes ◽  
Erickson Duarte Bonifácio de Assis ◽  
Suellen Marinho Andrade
Keyword(s):  
Neuropathic Pain ◽  
Pain Relief ◽  
Brachial Plexus ◽  
Outcome Measures ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Mirror Therapy ◽  
Double Blind ◽  
Direct Current Stimulation

Introduction: Although transcranial direct current stimulation (tDCS) and mirror therapy (MT) have benefits in combating chronic pain, there is still no evidence of the effects of the simultaneous application of these techniques in patients with neuropathic pain. This study aims to assess the efficacy of tDCS paired with MT in neuropathic pain after brachial plexus injury.Methods: In a sham controlled, double-blind, parallel-group design, 16 patients were randomized to receive active or sham tDCS administered during mirror therapy. Each patient received 12 treatment sessions, 30 min each, during a period of 4 weeks over M1 contralateral to the side of the injury. Outcome variables were evaluated at baseline and post-treatment using the McGill questionnaire, Brief Pain Inventory, and Medical Outcomes Study 36–Item Short-Form Health Survey. Long-term effects of treatment were evaluated at a 3-month follow-up.Results: An improvement in pain relief and quality of life were observed in both groups (p ≤ 0.05). However, active tDCS and mirror therapy resulted in greater improvements after the endpoint (p ≤ 0.02). No statistically significant differences in the outcome measures were identified among the groups at follow-up (p ≥ 0.12). A significant relationship was found between baseline pain intensity and outcome measures (p ≤ 0.04). Moreover, the results showed that state anxiety is closely linked to post-treatment pain relief (p ≤ 0.05).Conclusion: Active tDCS combined with mirror therapy has a short-term effect of pain relief, however, levels of pain and anxiety at the baseline should be considered.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT04385030.

Long-lasting analgesic effect of transcranial direct current stimulation in treatment of chronic endometriosis pain

2015 ◽  
Vol 41 (12) ◽  
pp. 1998-2001 ◽  
Author(s):  
Reza Rostami ◽  
Bashar W. Badran ◽  
Reza Kazemi ◽  
Mohammad Habibnezhad ◽  
Mark S. George
Keyword(s):  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Analgesic Effect ◽  
Direct Current Stimulation

scholarly journals Effect of transcranial direct current stimulation on post-stroke fatigue

2021 ◽  
Author(s):  
William De Doncker ◽  
Sasha Ondobaka ◽  
Annapoorna Kuppuswamy
Keyword(s):  
Motor Cortex ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Cortical Excitability ◽  
Secondary Outcome ◽  
Anodal Tdcs ◽  
Single Session ◽  
Direct Current Stimulation ◽  
Post Stroke ◽  
Perceived Effort

Abstract Background Fatigue is one of the most commonly reported symptoms post-stroke, which has a severe impact on the quality of life. Post-stroke fatigue is associated with reduced motor cortical excitability, specifically of the affected hemisphere. Objective The aim of this exploratory study was to assess whether fatigue symptoms can be reduced by increasing cortical excitability using anodal transcranial direct current stimulation (tDCS). Methods In this sham-controlled, double-blind intervention study, tDCS was applied bilaterally over the primary motor cortex in a single session in thirty stroke survivors with high severity of fatigue. A questionnaire-based measure of trait fatigue (primary outcome) was obtained before, after a week and 5 weeks post stimulation. Secondary outcome measures of state fatigue, motor cortex neurophysiology and perceived effort were also assessed pre, immediately post, a week and 5 weeks post stimulation. Results Anodal tDCS significantly improved fatigue symptoms a week after real stimulation when compared to sham stimulation. There was also a significant change in motor cortex neurophysiology of the affected hemisphere and perceived effort, a week after stimulation. The degree of improvement in fatigue was associated with baseline anxiety levels. Conclusion A single session of anodal tDCS improves fatigue symptoms with the effect lasting up to a week post stimulation. tDCS may therefore be a useful tool for managing fatigue symptoms post-stroke. Trial registration NCT04634864 Date of registration 17/11/2020–“retrospectively registered”.

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