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Sinha P, Shreekantiah U, Goyal N, Sreeraj VS, Arumugham SS, Samantaray S, Jammigumpula A, Nanjundaiah GKK, Venkataramaiah S, Thennarasu K, Roy C, Purohith AN, Shenoy S, Kumar CN, Shivakumar V, Udupa K, Muralidharan K, Venkatasubramanian G, Thirthalli J, Praharaj SK, Mehta UM. Study protocol for evaluating the clinical efficacy and neurobiological correlates of sequential treatment with tDCS primed iTBS and ECT in treatment-resistant depression. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.18192.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Treatment-resistant depression is a burdensome condition. Intermittent theta burst stimulation (iTBS) of the left dorsolateral prefrontal cortex is considered a treatment option in early course of resistance with a proportion of such patients responding to it. Preliminary evidence suggests a role of priming iTBS stimulation with preconditioning using cathodal transcranial direct current stimulation (tDCS). This protocol describes a double-blind randomized sham-controlled study to evaluate the clinical efficacy and tolerability of tDCS-primed iTBS in the treatment of resistant depression. Non-responders to this trial will be offered open-label electroconvulsive therapy. All participants will undergo neurobiological investigations that will enable the identification of potential response predictors and mechanisms. Methods: Three hundred and fifty consenting patients with treatment resistant depression will be randomly assigned to receive 20–30 daily sessions of true-tDCS or sham-tDCS primed iTBS over left dorsolateral prefrontal cortex at three study centers. After this blinded sham-controlled trial, non-responders to the intervention will be offered open-label true ECT. Clinical assessments, neurocognitive assessments and multimodal investigations (magnetic resonance imaging, electroencephalography, heart rate variability, investigative transcranial magnetic stimulation-transcranial direct current stimulation, gene polymorphisms) will be conducted at baseline and repeated after the end of the trial, as well as open-label ECT course. The trial will evaluate the improvement in depressive symptoms (Hamilton depression rating scale) between the two groups as the primary outcome measure.
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Noninvasive motor cortex stimulation effects on quantitative sensory testing in healthy and chronic pain subjects: a systematic review and meta-analysis. Pain 2021; 161:1955-1975. [PMID: 32453135 DOI: 10.1097/j.pain.0000000000001893] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/01/2020] [Indexed: 02/06/2023]
Abstract
ABSTRACT One of the potential mechanisms of motor cortex stimulation by noninvasive brain stimulation (NIBS) effects on pain is through the restoration of the defective endogenous inhibitory pain pathways. However, there are still limited data on quantitative sensory testing (QST), including conditioned pain modulation (CPM), supporting this mechanism. This systematic review and meta-analysis aimed to evaluate the effects of noninvasive motor cortex stimulation on pain perception as indexed by changes in QST outcomes. Database searches were conducted until July 2019 to include randomized controlled trials that performed sham-controlled NIBS on the motor cortex in either the healthy and/or pain population and assessed the QST and CPM. Quality of studies was assessed through the Cochrane tool. We calculated the Hedge's effect sizes of QST and CPM outcomes and their 95% confidence intervals (95% CIs) and performed random-effects meta-analyses. Thirty-eight studies were included (1178 participants). We found significant increases of pain threshold in healthy subjects (ES = 0.16, 95% CI = 0.02-0.31, I2 = 22.2%) and pain populations (ES = 0.48, 95% CI = 0.15-0.80, I2 = 68.8%), and homogeneous higher CPM effect (pain ratings reduction) in healthy subjects (ES = -0.39, 95% CI = -0.64 to -0.14, I2 = 17%) and pain populations (ES = -0.35, 95% CI = -0.60 to -0.11, I2 = 0%) in the active NIBS group compared with sham. These results support the idea of top-down modulation of endogenous pain pathways by motor cortex stimulation as one of the main mechanisms of pain reduction assessed by QST, which could be a useful predictive and prognostic biomarker for chronic pain personalized treatment with NIBS.
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Imamura Y, Okada-Ogawa A, Noma N, Shinozaki T, Watanabe K, Kohashi R, Shinoda M, Wada A, Abe O, Iwata K. A perspective from experimental studies of burning mouth syndrome. J Oral Sci 2020; 62:165-169. [PMID: 32161235 DOI: 10.2334/josnusd.19-0459] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Burning mouth syndrome (BMS) is one of the most frequently seen idiopathic pain conditions in a dental setting. Peri- and postmenopausal women are most frequently affected, and patients who experience BMS complain of persistent burning pain mainly at the tip and the bilateral border of the tongue. Recent studies have assessed whether BMS is a neuropathic pain condition, based on morphologic changes in biopsied tongue specimens, and whether there are abnormal pain responses in patients with this disease. Somatosensory studies have reported some abnormal findings in sensory and pain detection thresholds with inconsistency; however, the most distinct finding was exaggerated responses to painful stimuli. Imaging and electrophysiologic studies have suggested the possibility of dysregulation of the pain-modulating system in the central nervous system, which may explain the enhanced pain responses despite the lack of typical responses toward quantitative sensory tests. Basic studies have suggested the possible involvement of neuroprotective steroids, although the underlying mechanisms of this condition have not been elucidated. Experimental studies are looking for preferable supportive therapies for BMS patients despite the obscure pathogenesis.
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Affiliation(s)
- Yoshiki Imamura
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry.,Division of Clinical Research, Dental Research Institute, Nihon University School of Dentistry
| | - Akiko Okada-Ogawa
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry.,Division of Clinical Research, Dental Research Institute, Nihon University School of Dentistry
| | - Noboru Noma
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry.,Division of Clinical Research, Dental Research Institute, Nihon University School of Dentistry
| | - Takahiro Shinozaki
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry.,Division of Clinical Research, Dental Research Institute, Nihon University School of Dentistry
| | - Kosuke Watanabe
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry
| | - Ryutaro Kohashi
- Department of Dental Radiology, Nihon University School of Dentistry
| | - Masamichi Shinoda
- Department of Physiology, Nihon University School of Dentistry.,Division of Functional Morphology, Dental Research Institute, Nihon University School of Dentistry
| | - Akihiko Wada
- Department of Radiology, Juntendo University Faculty of Medicine
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo
| | - Koichi Iwata
- Department of Physiology, Nihon University School of Dentistry.,Division of Functional Morphology, Dental Research Institute, Nihon University School of Dentistry
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Motor corticospinal excitability: a novel facet of pain modulation? Pain Rep 2019; 4:e725. [PMID: 31041424 PMCID: PMC6455687 DOI: 10.1097/pr9.0000000000000725] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 01/20/2019] [Accepted: 01/30/2019] [Indexed: 12/13/2022] Open
Abstract
Introduction Increase in excitability of the primary motor cortex (M1) is associated with pain inhibition by analgesics, which is, in turn, associated with the psychophysical antinociceptive pain modulation profile. However, the relationship between neurophysiological M1 excitability and psychophysical pain modulation has not yet been explored. Objectives We aim to study these relationships in healthy subjects. Methods Forty-one young healthy subjects (22 women) underwent a wide battery of psychophysical testing that included conditioned pain modulation (CPM) and pain temporal summation, and a transcranial magnetic stimulation neurophysiological assessment of the motor corticospinal excitability, including resting motor threshold, motor-evoked potentials (MEPs), and cortical silent period. Results Increased motor corticospinal excitability in 2 parameters was associated with more efficient CPM: (1) higher MEP amplitude (r = -0.574; P _Bonferroni = 0.02) and (2) longer MEP duration (r = -0.543; P _Bonferroni = 0.02). The latter also correlated with the lower temporal summation magnitude (r = -0.421; P = 0.007); however, on multiplicity adjustment, significance was lost. Conclusions Increased corticospinal excitability of the primary motor cortex is associated with more efficient inhibitory pain modulation as assessed by CPM, in healthy subjects. Motor-evoked potential amplitude and duration may be considered as an additional, objective and easy to measure parameter to allow for better individual assessment of pain modulation profile.
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Pazzaglia C, Vollono C, Testani E, Coraci D, Granata G, Padua L, Valeriani M. Low-Frequency rTMS of the Primary Motor Area Does Not Modify the Response of the Cerebral Cortex to Phasic Nociceptive Stimuli. Front Neurosci 2018; 12:878. [PMID: 30555294 PMCID: PMC6281959 DOI: 10.3389/fnins.2018.00878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 11/12/2018] [Indexed: 01/12/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive technique of cortical stimulation. Although the exact mechanism of action is not clearly understood, it has been postulated that rTMS action on pain depends most on stimulation sites and stimulation parameters. Most studies concern high-frequency rTMS of the primary motor cortex (M1). High-frequency rTMS over motor cortex seems to induce an analgesic effect while contrasting results were reported after low-frequency rTMS. The aim of the current study was to investigate the effects of 1 Hz rTMS stimulation over the left primary motor cortex on subjective laser pain rating and laser evoked potential (LEP) amplitudes in healthy subjects. Subjects underwent two different sessions (real and sham rTMS) according to a cross-sectional design. In each session, LEPs and laser-pain rating to stimulation of both right and left hand dorsum were collected before 1 Hz rTMS over the left M1 area (baseline), which lasted 20 min. Then, LEPs and laser-pain rating were measured immediately after rTMS (T0), after 20 min from T0 (T0+20), and after 40 min from T0 (T0+40). We could not find any modification of both laser-pain rating and LEP parameters (latencies and amplitudes) following 1 Hz rTMS. Therefore, our results show that the low-frequency rTMS of the M1 area does not change the response of the cerebral cortex to pain.
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Affiliation(s)
- Costanza Pazzaglia
- Unit of High Intensity Neurorehabilitation, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Catello Vollono
- Department of Geriatrics, Neuroscience and Orthopedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Elisa Testani
- Department of Neurological and Neurosensory Sciences, University Hospital of Siena, Siena, Italy
| | | | - Giuseppe Granata
- Department of Geriatrics, Neuroscience and Orthopedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Luca Padua
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.,Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Massimiliano Valeriani
- Department of Neuroscience, Pediatric Hospital Bambino Gesù, Rome, Italy.,Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
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Nardone R, Brigo F, Höller Y, Sebastianelli L, Versace V, Saltuari L, Lochner P, Trinka E. Transcranial magnetic stimulation studies in complex regional pain syndrome type I: A review. Acta Neurol Scand 2018; 137:158-164. [PMID: 28971481 DOI: 10.1111/ane.12852] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2017] [Indexed: 01/23/2023]
Abstract
The sensory and motor cortical representation corresponding to the affected limb is altered in patients with complex regional pain syndrome (CRPS). Transcranial magnetic stimulation (TMS) represents a useful non-invasive approach for studying cortical physiology. If delivered repetitively, TMS can also modulate cortical excitability and induce long-lasting neuroplastic changes. In this review, we performed a systematic search of all studies using TMS to explore cortical excitability/plasticity and repetitive TMS (rTMS) for the treatment of CRPS. Literature searches were conducted using PubMed and EMBASE. We identified 8 articles matching the inclusion criteria. One hundred fourteen patients (76 females and 38 males) were included in these studies. Most of them have applied TMS in order to physiologically characterize CRPS type I. Changes in motor cortex excitability and brain mapping have been reported in CRPS-I patients. Sensory and motor hyperexcitability are in the most studies bilateral and likely involve corresponding regions within the central nervous system rather than the entire hemisphere. Conversely, sensorimotor integration and plasticity were found to be normal in CRPS-I. TMS examinations also revealed that the nature of motor dysfunction in CRPS-I patients differs from that observed in patients with functional movement disorders, limb immobilization, or idiopathic dystonia. TMS studies may thus lead to the implementation of correct rehabilitation strategies in CRPS-I patients. Two studies have begun to therapeutically use rTMS. This non-invasive brain stimulation technique could have therapeutic utility in CRPS, but further well-designed studies are needed to corroborate initial findings.
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Affiliation(s)
- R. Nardone
- Department of Neurology Franz Tappeiner Hospital Merano Italy
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg Austria
| | - F. Brigo
- Department of Neurology Franz Tappeiner Hospital Merano Italy
- Department of Neuroscience, Biomedicine and Movement Science University of Verona Verona Italy
| | - Y. Höller
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
| | - L. Sebastianelli
- Department of Neurorehabilitation Hospital of Vipiteno, and Research Department for Neurorehabilitation South Tyrol Bolzano Italy
| | - V. Versace
- Department of Neurorehabilitation Hospital of Vipiteno, and Research Department for Neurorehabilitation South Tyrol Bolzano Italy
| | - L. Saltuari
- Department of Neurorehabilitation Hospital of Vipiteno, and Research Department for Neurorehabilitation South Tyrol Bolzano Italy
- Department of Neurology Hochzirl Hospital Zirl Austria
| | - P. Lochner
- Department of Neurology Saarland University Medical Center Homburg Germany
| | - E. Trinka
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg Austria
- University for Medical Informatics and Health Technology, UMIT Hall in Tirol Austria
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Zhao H, Qiao L, Fan D, Zhang S, Turel O, Li Y, Li J, Xue G, Chen A, He Q. Modulation of Brain Activity with Noninvasive Transcranial Direct Current Stimulation (tDCS): Clinical Applications and Safety Concerns. Front Psychol 2017; 8:685. [PMID: 28539894 PMCID: PMC5423956 DOI: 10.3389/fpsyg.2017.00685] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 04/19/2017] [Indexed: 11/13/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a widely-used tool to induce neuroplasticity and modulate cortical function by applying weak direct current over the scalp. In this review, we first introduce the underlying mechanism of action, the brief history from discovery to clinical scientific research, electrode positioning and montages, and parameter setup of tDCS. Then, we review tDCS application in clinical samples including people with drug addiction, major depression disorder, Alzheimer's disease, as well as in children. This review covers the typical characteristics and the underlying neural mechanisms of tDCS treatment in such studies. This is followed by a discussion of safety, especially when the current intensity is increased or the stimulation duration is prolonged. Given such concerns, we provide detailed suggestions regarding safety procedures for tDCS operation. Lastly, future research directions are discussed. They include foci on the development of multi-tech combination with tDCS such as with TMS and fMRI; long-term behavioral and morphological changes; possible applications in other research domains, and more animal research to deepen the understanding of the biological and physiological mechanisms of tDCS stimulation.
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Affiliation(s)
- Haichao Zhao
- Faculty of Psychology, Southwest UniversityChongqing, China
| | - Lei Qiao
- Faculty of Psychology, Southwest UniversityChongqing, China
| | - Dongqiong Fan
- Faculty of Psychology, Southwest UniversityChongqing, China
| | - Shuyue Zhang
- School of Education, Guangxi UniversityNanning, China
| | - Ofir Turel
- Department of Information systems and Decision Sciences, College of Business and Economics, California State University, FullertonFullerton, CA, USA
| | - Yonghui Li
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of SciencesBeijing, China
| | - Jun Li
- National Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal UniversityBeijing, China
| | - Gui Xue
- National Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal UniversityBeijing, China
| | - Antao Chen
- Faculty of Psychology, Southwest UniversityChongqing, China
| | - Qinghua He
- Faculty of Psychology, Southwest UniversityChongqing, China.,Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of SciencesBeijing, China.,Southwest University Branch, Collaborative Innovation Center of Assessment toward Basic Education Quality at Beijing Normal UniversityChongqing, China
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8
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Naro A, Milardi D, Russo M, Terranova C, Rizzo V, Cacciola A, Marino S, Calabro RS, Quartarone A. Non-invasive Brain Stimulation, a Tool to Revert Maladaptive Plasticity in Neuropathic Pain. Front Hum Neurosci 2016; 10:376. [PMID: 27512368 PMCID: PMC4961691 DOI: 10.3389/fnhum.2016.00376] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/12/2016] [Indexed: 12/18/2022] Open
Abstract
Neuromodulatory effects of non-invasive brain stimulation (NIBS) have been extensively studied in chronic pain. A hypothetic mechanism of action would be to prevent or revert the ongoing maladaptive plasticity within the pain matrix. In this review, the authors discuss the mechanisms underlying the development of maladaptive plasticity in patients with chronic pain and the putative mechanisms of NIBS in modulating synaptic plasticity in neuropathic pain conditions.
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Affiliation(s)
- Antonino Naro
- IRCCS Centro Neurolesi "Bonino-Pulejo" Messina, Italy
| | - Demetrio Milardi
- IRCCS Centro Neurolesi "Bonino-Pulejo"Messina, Italy; Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of MessinaMessina, Italy
| | | | - Carmen Terranova
- Department of Clinical and Experimental Medicine, University of Messina Messina, Italy
| | - Vincenzo Rizzo
- Department of Clinical and Experimental Medicine, University of Messina Messina, Italy
| | - Alberto Cacciola
- IRCCS Centro Neurolesi "Bonino-Pulejo"Messina, Italy; Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of MessinaMessina, Italy
| | - Silvia Marino
- IRCCS Centro Neurolesi "Bonino-Pulejo" Messina, Italy
| | | | - Angelo Quartarone
- IRCCS Centro Neurolesi "Bonino-Pulejo"Messina, Italy; Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of MessinaMessina, Italy
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9
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Filmer HL, Dux PE, Mattingley JB. Applications of transcranial direct current stimulation for understanding brain function. Trends Neurosci 2014; 37:742-53. [PMID: 25189102 DOI: 10.1016/j.tins.2014.08.003] [Citation(s) in RCA: 304] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/08/2014] [Accepted: 08/12/2014] [Indexed: 12/29/2022]
Affiliation(s)
- Hannah L Filmer
- School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia.
| | - Paul E Dux
- School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Jason B Mattingley
- School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia; Queensland Brain Institute, The University of Queensland, St Lucia QLD 4072 Australia
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10
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Choi YH, Jung SJ, Lee CH, Lee SU. Additional effects of transcranial direct-current stimulation and trigger-point injection for treatment of myofascial pain syndrome: a pilot study with randomized, single-blinded trial. J Altern Complement Med 2014; 20:698-704. [PMID: 25083759 DOI: 10.1089/acm.2013.0243] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Chronic pain caused by myofascial pain syndrome (MPS) results in generalized and debilitating conditions. Trigger-point injection (TPI) is the mainstay of MPS management to reduce acute and localized pain. Other adjunctive intervention to modulate the central pain pathway might be helpful if they are combined with TPI. Transcranial direct-current stimulation (tDCS), which is a form of neurostimulation, has been reported to be safe and effective in treating chronic pain by changing cortical excitability. OBJECTIVES To determine whether there is an additional effect of tDCS and TPI to reduce pain in patients with MPS. PATIENTS Twenty-one patients with newly diagnosed MPS of shoulder girdle muscles. INTERVENTIONS Patients were randomly assigned into 1 of 3 groups (2 active and 1 sham stimulation groups) and received TPI. Immediately after TPI, tDCS (2 mA for 20 minutes on 5 consecutive days) was administered. For the active stimulation groups, tDCS was applied over 2 different locations (primary motor cortex and dorsolateral prefrontal cortex [DLPFC]). OUTCOME MEASURES Visual analogue scale (VAS), Pain Threshold Test, and short form of the McGill Pain Questionnaire were measured before and immediately after stimulation for 5 consecutive days. RESULTS The mean VAS values were decreased in all three groups after 5 days. There was a significant change between before and after stimulation only in the DLPFC group. The significant change in the mean VAS value was shown from after the second stimulation session (p=0.031), and this remained significant until the last stimulation session (p=0.027). CONCLUSION This study suggests that tDCS over DLPFC may have additional effects with TPI to reduce pain in patients with MPS. tDCS over DLPFC can be used to reverse central pain pathway by modulating cortical plasticity.
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Affiliation(s)
- Yoon-Hee Choi
- 1 Department of Rehabilitation Medicine, Seoul National University Hospital , Seoul, South Korea
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11
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DosSantos MF, Martikainen IK, Nascimento TD, Love TM, DeBoer MD, Schambra HM, Bikson M, Zubieta JK, DaSilva AF. Building up analgesia in humans via the endogenous μ-opioid system by combining placebo and active tDCS: a preliminary report. PLoS One 2014; 9:e102350. [PMID: 25029273 PMCID: PMC4100885 DOI: 10.1371/journal.pone.0102350] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/18/2014] [Indexed: 01/24/2023] Open
Abstract
Transcranial Direct Current Stimulation (tDCS) is a method of non-invasive brain stimulation that has been frequently used in experimental and clinical pain studies. However, the molecular mechanisms underlying tDCS-mediated pain control, and most important its placebo component, are not completely established. In this pilot study, we investigated in vivo the involvement of the endogenous μ-opioid system in the global tDCS-analgesia experience. Nine healthy volunteers went through positron emission tomography (PET) scans with [11C]carfentanil, a selective μ-opioid receptor (MOR) radiotracer, to measure the central MOR activity during tDCS in vivo (non-displaceable binding potential, BPND)--one of the main analgesic mechanisms in the brain. Placebo and real anodal primary motor cortex (M1/2mA) tDCS were delivered sequentially for 20 minutes each during the PET scan. The initial placebo tDCS phase induced a decrease in MOR BPND in the periaqueductal gray matter (PAG), precuneus, and thalamus, indicating activation of endogenous μ-opioid neurotransmission, even before the active tDCS. The subsequent real tDCS also induced MOR activation in the PAG and precuneus, which were positively correlated to the changes observed with placebo tDCS. Nonetheless, real tDCS had an additional MOR activation in the left prefrontal cortex. Although significant changes in the MOR BPND occurred with both placebo and real tDCS, significant analgesic effects, measured by improvements in the heat and cold pain thresholds, were only observed after real tDCS, not the placebo tDCS. This study gives preliminary evidence that the analgesic effects reported with M1-tDCS, can be in part related to the recruitment of the same endogenous MOR mechanisms induced by placebo, and that such effects can be purposely optimized by real tDCS.
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Affiliation(s)
- Marcos F. DosSantos
- Headache & Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences & Michigan Center for Oral Health Research (MCOHR), School of Dentistry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Ilkka K. Martikainen
- Headache & Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences & Michigan Center for Oral Health Research (MCOHR), School of Dentistry, University of Michigan, Ann Arbor, Michigan, United States of America
- Translational Neuroimaging Laboratory, Molecular and Behavioral Neuroscience Institute (MBNI), University of Michigan, Ann Arbor, Michigan, United States of America
| | - Thiago D. Nascimento
- Headache & Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences & Michigan Center for Oral Health Research (MCOHR), School of Dentistry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Tiffany M. Love
- Translational Neuroimaging Laboratory, Molecular and Behavioral Neuroscience Institute (MBNI), University of Michigan, Ann Arbor, Michigan, United States of America
| | - Misty D. DeBoer
- Headache & Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences & Michigan Center for Oral Health Research (MCOHR), School of Dentistry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Heidi M. Schambra
- Departments of Neurology and Rehabilitation & Regenerative Medicine, Columbia University, New York, New York, United States of America
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York, New York, New York, United States of America
| | - Jon-Kar Zubieta
- Translational Neuroimaging Laboratory, Molecular and Behavioral Neuroscience Institute (MBNI), University of Michigan, Ann Arbor, Michigan, United States of America
| | - Alexandre F. DaSilva
- Headache & Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences & Michigan Center for Oral Health Research (MCOHR), School of Dentistry, University of Michigan, Ann Arbor, Michigan, United States of America
- Translational Neuroimaging Laboratory, Molecular and Behavioral Neuroscience Institute (MBNI), University of Michigan, Ann Arbor, Michigan, United States of America
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12
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Moloney TM, Witney AG. Pressure pain thresholds increase after preconditioning 1 Hz repetitive transcranial magnetic stimulation with transcranial direct current stimulation. PLoS One 2014; 9:e92540. [PMID: 24658333 PMCID: PMC3962424 DOI: 10.1371/journal.pone.0092540] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 02/24/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The primary motor cortex (M1) is an effective target of non-invasive cortical stimulation (NICS) for pain threshold modulation. It has been suggested that the initial level of cortical excitability of M1 plays a key role in the plastic effects of NICS. OBJECTIVE Here we investigate whether transcranial direct current stimulation (tDCS) primed 1 Hz repetitive transcranial magnetic stimulation (rTMS) modulates experimental pressure pain thresholds and if this is related to observed alterations in cortical excitability. METHOD 15 healthy, male participants received 10 min 1 mA anodal, cathodal and sham tDCS to the left M1 before 15 min 1 Hz rTMS in separate sessions over a period of 3 weeks. Motor cortical excitability was recorded at baseline, post-tDCS priming and post-rTMS through recording motor evoked potentials (MEPs) from right FDI muscle. Pressure pain thresholds were determined by quantitative sensory testing (QST) through a computerized algometer, on the palmar thenar of the right hand pre- and post-stimulation. RESULTS Cathodal tDCS-primed 1 Hz-rTMS was found to reverse the expected suppressive effect of 1 Hz rTMS on cortical excitability; leading to an overall increase in activity (p<0.001) with a parallel increase in pressure pain thresholds (p<0.01). In contrast, anodal tDCS-primed 1 Hz-rTMS resulted in a corresponding decrease in cortical excitability (p<0.05), with no significant effect on pressure pain. CONCLUSION This study demonstrates that priming the M1 before stimulation of 1 Hz-rTMS modulates experimental pressure pain thresholds in a safe and controlled manner, producing a form of analgesia.
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Affiliation(s)
- Tonya M. Moloney
- Department of Physiology, Trinity College Institute of Neuroscience and Trinity Centre for BioEngineering, Trinity College, Dublin, Ireland
| | - Alice G. Witney
- Department of Physiology, Trinity College Institute of Neuroscience and Trinity Centre for BioEngineering, Trinity College, Dublin, Ireland
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