A sham-controlled, phase II trial of transcranial direct current stimulation for the treatment of central pain in traumatic spinal cord injury

• Published in: Pain (Amsterdam) Vol. 122; no. 1; pp. 197 - 209
• Main Authors: Fregni, Felipe, Boggio, Paulo S., Lima, Moises C., Ferreira, Merari J.L., Wagner, Tim, Rigonatti, Sergio P., Castro, Anita W., Souza, Daniel R., Riberto, Marcelo, Freedman, Steven D., Nitsche, Michael A., Pascual-Leone, Alvaro
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier B.V 01-05-2006; Elsevier
• Subjects: Adult; Biological and medical sciences; Brain polarization; Central pain; Cerebral Cortex; Double-Blind Method; Electric Stimulation Therapy - methods; Electric Stimulation Therapy - trends; Female; Fundamental and applied biological sciences. Psychology; Humans; Illness and personality; Illness, stress and coping; Male; Neuralgia - etiology; Neuralgia - therapy; Placebo Effect; Practice Patterns, Physicians' - trends; Prognosis; Psychology and medicine; Psychology. Psychoanalysis. Psychiatry; Psychology. Psychophysiology; Single-Blind Method; Somesthesis and somesthetic pathways (proprioception, exteroception, nociception); interoception; electrolocation. Sensory receptors; Spinal Cord Injuries - complications; Spinal Cord Injuries - therapy; Spinal cord injury; Transcranial direct current stimulation; Transcranial Magnetic Stimulation - methods; Transcranial Magnetic Stimulation - trends; Treatment Outcome; Vertebrates: nervous system and sense organs; Spinal cord injury; Transcranial direct current stimulation; Brain polarization; Central pain; Human; Affect affectivity; Evaluation; Spinal cord; Motor pathway; Evaluation scale; Visual analogue scale; Central nervous system; Encephalon; Improvement; Pain; Treatment; Direct current; Motor cortex; Anxiety; Safety; Technique
• ISSN: 0304-3959; 1872-6623
• DOI: 10.1016/j.pain.2006.02.023

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 (2
mA, 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.