title: A feasibility study assessing cortical plasticity in chronic neuropathic pain following burn injury.
abstract: The aim of this article is to evaluate the neuroplastic changes associated with chronic neuropathic pain following burn injury and modulation feasibility using transcranial direct current stimulation (tDCS). This is a crossover, double-blinded case series involving three patients with chronic neuropathic pain following burn injury. Participants were randomly assigned to undergo single sessions of both sham and active anodal tDCS over the primary motor cortex, contralateral to the most painful site. Excitability of the motor cortex was assessed before and after each stimulation session with the use of transcranial magnetic stimulation. An overall decrease in cortical excitability was seen after active tDCS only, as characterized by a decrease in intracortical facilitation and amplitude of motor evoked potentials and an increase in intracortical inhibition. Clinical outcomes did not change after a single session of tDCS. Results are consistent with previous studies showing that patients with chronic neuropathic pain have defective intracortical inhibition. This case series shows early evidence that chronic pain following burn injury may share similar central neural mechanisms, which could be modulated using tDCS.
authors.affiliation: Laboratory of Neuromodulation, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
authors.forename: Andrea Santos
authors.initials: AS
authors.lastname: Portilla
authors.forename: Gabriela L
authors.initials: GL
authors.lastname: Bravo
authors.forename: Fiorella K
authors.initials: FK
authors.lastname: Miraval
authors.forename: Mauricio F
authors.initials: MF
authors.lastname: Villamar
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Schneider
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Ryan
authors.forename: Felipe
authors.initials: F
authors.lastname: Fregni
mesh_terms: D000328:Adult; D002056:Burns / Q000503:physiopathology* / Q000534:rehabilitation; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004599:Electric Stimulation Therapy; D019054:Evoked Potentials, Motor / Q000502:physiology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000503:physiopathology* / Q000534:rehabilitation; D009473:Neuronal Plasticity / Q000502:physiology*; D010147:Pain Measurement; D011795:Surveys and Questionnaires; D016896:Treatment Outcome