A sham-controlled, phase II trial of transcranial direct current stimulation for the treatment of central pain in traumatic spinal cord injury.
Past evidence has shown that motor cortical stimulation with invasive and non-invasive brain stimulation is effective to relieve central pain. Here we aimed to study the effects of another, very safe technique of non-invasive brain stimulation--transcranial direct current stimulation (tDCS)--on pain control in patients with central pain due to traumatic spinal cord injury. Patients were randomized to receive sham or active motor tDCS (2mA, 20 min for 5 consecutive days). A blinded evaluator rated the pain using the visual analogue scale for pain, Clinician Global Impression and Patient Global Assessment. Safety was assessed with a neuropsychological battery and confounders with the evaluation of depression and anxiety changes. There was a significant pain improvement after active anodal stimulation of the motor cortex, but not after sham stimulation. These results were not confounded by depression or anxiety changes. Furthermore, cognitive performance was not significantly changed throughout the trial in both treatment groups. The results of our study suggest that this new approach of cortical stimulation can be effective to control pain in patients with spinal cord lesion. We discuss potential mechanisms for pain amelioration after tDCS, such as a secondary modulation of thalamic nuclei activity.
Harvard Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. ffregni@bidmc.harvard.edu
Felipe
F
Fregni
Paulo S
PS
Boggio
Moises C
MC
Lima
Merari J L
MJ
Ferreira
Tim
T
Wagner
Sergio P
SP
Rigonatti
Anita W
AW
Castro
Daniel R
DR
Souza
Marcelo
M
Riberto
Steven D
SD
Freedman
Michael A
MA
Nitsche
Alvaro
A
Pascual-Leone
D000328:Adult; D002540:Cerebral Cortex; D004311:Double-Blind Method; D004599:Electric Stimulation Therapy / Q000379:methods* / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D009437:Neuralgia / Q000209:etiology* / Q000628:therapy*; D015990:Placebo Effect; D010818:Practice Patterns, Physicians' / Q000639:trends; D011379:Prognosis; D016037:Single-Blind Method; D013119:Spinal Cord Injuries / Q000150:complications* / Q000628:therapy*; D050781:Transcranial Magnetic Stimulation / Q000379:methods* / Q000639:trends*; D016896:Treatment Outcome