title: Anodal transcranial direct current stimulation over the left dorsolateral prefrontal cortex modulates attention and pain in fibromyalgia: randomized clinical trial.
abstract: Cognitive dysfunction in fibromyalgia patients has been reported, especially when increased attentional demands are required. Transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) has been effective in modulating attention. We tested the effects of a single session of tDCS coupled with a Go/No-go task in modulating three distinct attentional networks: alertness, orienting and executive control. Secondarily, the effect on pain measures was evaluated. Forty females with fibromyalgia were randomized to receive active or sham tDCS. Anodal stimulation (1 mA, 20 min) was applied over the DLPFC. Attention indices were assessed using the Attention Network Test (ANT). Heat pain threshold (HPTh) and tolerance (HPTo) were measured. Active compared to sham tDCS led to increased performance in the orienting (mean difference [MD] = 14.63) and executive (MD = 21.00) attention networks. There was no effect on alertness. Active tDCS increased HPTh as compared to sham (MD = 1.93) and HPTo (MD = 1.52). Regression analysis showed the effect on executive attention is mostly independent of the effect on pain. DLPFC may be an important target for neurostimulation therapies in addition to the primary motor cortex for patients who do not respond adequately to neurostimulation therapies.
authors.affiliation: Post Graduate Program in Medical Sciences, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Adriana Ferreira
authors.initials: AF
authors.lastname: Silva
authors.affiliation: Post Graduate Program in Medical Sciences, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.|Laboratory of Pain & Neuromodulation, Clinical Hospital of Porto Alegre, Porto Alegre, Brazil.
authors.forename: Maxciel
authors.initials: M
authors.lastname: Zortea
authors.affiliation: Spaulding Center of Neuromodulation, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.|Neuropsychophysiology Laboratory, CIPsi, School of Psychology (EPsi), University of Minho, Braga, Portugal.
authors.forename: Sandra
authors.initials: S
authors.lastname: Carvalho
authors.affiliation: Spaulding Center of Neuromodulation, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.|Neuropsychophysiology Laboratory, CIPsi, School of Psychology (EPsi), University of Minho, Braga, Portugal.
authors.forename: Jorge
authors.identifier: 0000-0002-0323-9012
authors.initials: J
authors.lastname: Leite
authors.affiliation: Post Graduate Program in Medical Sciences, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.|Pharmacology Department, Institute of Basic Health Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Iraci Lucena da Silva
authors.initials: IL
authors.lastname: Torres
authors.affiliation: Spaulding Center of Neuromodulation, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Felipe
authors.initials: F
authors.lastname: Fregni
authors.affiliation: Post Graduate Program in Medical Sciences, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. caumo@cpovo.net.|Laboratory of Pain & Neuromodulation, Clinical Hospital of Porto Alegre, Porto Alegre, Brazil. caumo@cpovo.net.|Pharmacology Department, Institute of Basic Health Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. caumo@cpovo.net.|Pain and Palliative Care Service, Clinical Hospital of Porto Alegre, Porto Alegre, Brazil. caumo@cpovo.net.|Surgery Department, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. caumo@cpovo.net.
authors.forename: Wolnei
authors.initials: W
authors.lastname: Caumo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001288:Attention; D056344:Executive Function; D005260:Female; D005356:Fibromyalgia / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D008875:Middle Aged; D010146:Pain / Q000150:complications / Q000503:physiopathology*; D059408:Pain Management / Q000379:methods*; D017288:Pain Threshold; D017397:Prefrontal Cortex / Q000503:physiopathology*; D011597:Psychomotor Performance; D065908:Transcranial Direct Current Stimulation; D055815:Young Adult