title: Immediate and Sustained Effects of 5-Day Transcranial Direct Current Stimulation of the Motor Cortex in Phantom Limb Pain.
abstract: The study explored the analgesic effects of transcranial direct current stimulation (tDCS) over the motor cortex on postamputation phantom limb pain (PLP). Eight subjects with unilateral lower or upper limb amputation and chronic PLP were enrolled in a crossover, double-blind, sham-controlled treatment program. For 5 consecutive days, anodal (active or sham) tDCS was applied over the motor cortex for 15 minutes at an intensity of 1.5 mA. The 5-day treatment with active, but not sham, tDCS induced a sustained decrease in background PLP and in the frequency of PLP paroxysms, which lasted for 1 week after the end of treatment. Moreover, on each day of active tDCS, patients reported an immediate PLP relief, along with an increased ability to move their phantom limb. Patients' immediate responses to sham tDCS, on the contrary, were variable, marked by an increase or decrease of PLP levels from baseline. These results show that a 5-day treatment of motor cortex stimulation with tDCS can induce stable relief from PLP in amputees. Neuromodulation targeting the motor cortex appears to be a promising option for the management of this debilitating neuropathic pain condition, which is often refractory to classic pharmacologic and surgical treatments.
  
  
  CONCLUSIONS
  The study describes sustained and immediate effects of motor cortex stimulation by tDCS on postamputation PLP, whose analgesic action seems linked to the motor reactivation of the phantom limb. These results are helpful for the exploitation of tDCS as a therapeutic tool for the management of neuropathic pain.
authors: Department of Psychology, University of Milano-Bicocca, Milano, Italy; Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milano, Italy. Electronic address: nadia.bolognini@unimib.it.
authors: Nadia
authors: N
authors: Bolognini
authors: Department of Psychology, University of Milano-Bicocca, Milano, Italy; Department of Neuroscience, Azienda Ospedaliera "Alessandro Manzoni," Lecco, Italy.
authors: Viviana
authors: V
authors: Spandri
authors: Department of Rehabilitation, Azienda Ospedaliera "Carlo Poma," Mantova, Italy.
authors: Francesco
authors: F
authors: Ferraro
authors: Department of Neuroscience, Azienda Ospedaliera "Alessandro Manzoni," Lecco, Italy.
authors: Andrea
authors: A
authors: Salmaggi
authors: Vascular Surgery Unit, Azienda Ospedaliera "Alessandro Manzoni," Lecco, Italy.
authors: Alessandro C L
authors: AC
authors: Molinari
authors: Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Felipe
authors: F
authors: Fregni
authors: Department of Psychology, University of Milano-Bicocca, Milano, Italy.
authors: Angelo
authors: A
authors: Maravita
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology*; D010147:Pain Measurement; D010591:Phantom Limb / Q000503:physiopathology / Q000628:therapy*; D011795:Surveys and Questionnaires; D013997:Time Factors; D065908:Transcranial Direct Current Stimulation / Q000379:methods*
keywords: Phantom limb pain; motor cortex; neuroplasticity; phantom movement; transcranial direct current stimulation