Transcranial DC stimulation coupled with TENS for the treatment of chronic pain: a preliminary study.
OBJECTIVE
Based on evidence showing that electrical stimulation of the nervous system is an effective method to decrease chronic neurogenic pain, we aimed to investigate whether the combination of 2 methods of electrical stimulation-a method of peripheral stimulation [transcutaneous electrical nerve stimulation (TENS)] and a method of noninvasive brain stimulation [transcranial direct current stimulation (tDCS)]-induces greater pain reduction as compared with tDCS alone and sham stimulation.


METHODS
We performed a preliminary, randomized, sham-controlled, crossover, clinical study in which 8 patients were randomized to receive active tDCS/active TENS ("tDCS/TENS" group), active tDCS/sham TENS ("tDCS" group), and sham tDCS/sham TENS ("sham" group) stimulation. Assessments were performed immediately before and after each condition by a blinded rater.


RESULTS
The results showed that there was a significant difference in pain reduction across the conditions of stimulation (P=0.006). Post hoc tests showed significant pain reduction as compared with baseline after the tDCS/TENS condition [reduction by 36.5% (+/-10.7), P=0.004] and the tDCS condition [reduction by 15.5% (+/-4.9), P=0.014], but not after sham stimulation (P=0.35). In addition, tDCS/TENS induced greater pain reduction than tDCS (P=0.02).


CONCLUSIONS
The results of this pilot study suggest that the combination of TENS with tDCS has a superior effect compared with tDCS alone.
Boggio
Paulo S
PS
Núcleo de Neurociências, Centro de Ciências Biológicas e da Saúde, Universidade Presbiteriana Mackenzie, Sao Paulo, Brazil.
Amancio
Edson J
EJ
Correa
Claudio F
CF
Cecilio
Sofia
S
Valasek
Claudia
C
Bajwa
Zahid
Z
Freedman
Steven D
SD
Pascual-Leone
Alvaro
A
Edwards
Dylan J
DJ
Fregni
Felipe
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm; D001921:Brain / Q000502:physiology*; D002908:Chronic Disease; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D004599:Electric Stimulation Therapy / Q000009:adverse effects; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010147:Pain Measurement; D004561:Transcutaneous Electric Nerve Stimulation / Q000009:adverse effects