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Caravati E, Barbeni F, Chiarion G, Raggi M, Mesin L. Closed-Loop Transcranial Electrical Neurostimulation for Sustained Attention Enhancement: A Pilot Study towards Personalized Intervention Strategies. Bioengineering (Basel) 2024; 11:467. [PMID: 38790334 PMCID: PMC11118513 DOI: 10.3390/bioengineering11050467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/03/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
Sustained attention is pivotal for tasks like studying and working for which focus and low distractions are necessary for peak productivity. This study explores the effectiveness of adaptive transcranial direct current stimulation (tDCS) in either the frontal or parietal region to enhance sustained attention. The research involved ten healthy university students performing the Continuous Performance Task-AX (AX-CPT) while receiving either frontal or parietal tDCS. The study comprised three phases. First, we acquired the electroencephalography (EEG) signal to identify the most suitable metrics related to attention states. Among different spectral and complexity metrics computed on 3 s epochs of EEG, the Fuzzy Entropy and Multiscale Sample Entropy Index of frontal channels were selected. Secondly, we assessed how tDCS at a fixed 1.0 mA current affects attentional performance. Finally, a real-time experiment involving continuous metric monitoring allowed personalized dynamic optimization of the current amplitude and stimulation site (frontal or parietal). The findings reveal statistically significant improvements in mean accuracy (94.04 vs. 90.82%) and reaction times (262.93 vs. 302.03 ms) with the adaptive tDCS compared to a non-stimulation condition. Average reaction times were statistically shorter during adaptive stimulation compared to a fixed current amplitude condition (262.93 vs. 283.56 ms), while mean accuracy stayed similar (94.04 vs. 93.36%, improvement not statistically significant). Despite the limited number of subjects, this work points out the promising potential of adaptive tDCS as a tailored treatment for enhancing sustained attention.
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Affiliation(s)
| | | | | | | | - Luca Mesin
- Mathematical Biology and Physiology, Department Electronics and Telecommunications, Politecnico di Torino, 10129 Turin, Italy; (E.C.); (F.B.); (G.C.); (M.R.)
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Dai J, Xiao Y, Chen G, Gu Z, Xu K. Anodal transcranial direct current stimulation enhances response inhibition and attention allocation in fencers. PeerJ 2024; 12:e17288. [PMID: 38699193 PMCID: PMC11064870 DOI: 10.7717/peerj.17288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/02/2024] [Indexed: 05/05/2024] Open
Abstract
Background The aim of this study is to investigate the acute effects of anodal transcranial direct current stimulation (tDCS) on reaction time, response inhibition and attention in fencers. Methods Sixteen professional female fencers were recruited, and subjected to anodal tDCS and sham stimulation in the primary motor area (M1) one week apart in a randomized, crossover, single-blind design. A two-factor analysis of variance with repeated measures was used to analyze the effects of stimulation conditions (anodal stimulation, sham stimulation) and time (pre-stimulation, post-stimulation) on reaction time, response inhibition, and attention in fencers. Results The study found a significant improvement in response inhibition and attention allocation from pre-stimulation to post-stimulation following anodal tDCS but not after sham stimulation. There was no statistically significant improvement in reaction time and selective attention. Conclusions A single session of anodal tDCS could improve response inhibition, attention allocation in female fencers. This shows that tDCS has potential to improve aspects of an athlete's cognitive performance, although we do not know if such improvements would transfer to improved performance in competition. However, more studies involving all genders, large samples, and different sports groups are needed in the future to further validate the effect of tDCS in improving the cognitive performance of athletes.
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Affiliation(s)
- Jiansong Dai
- Department of Sport and Health Sciences, Nanjing Sport Institute, Nanjing, China
| | - Yang Xiao
- Department of Graduate, Nanjing Sport Institute, Nanjing, China
| | - Gangrui Chen
- Department of Sport Research, Nanjing Sport Institute, Nanjing, China
| | - Zhongke Gu
- Department of Sport and Health Sciences, Nanjing Sport Institute, Nanjing, China
| | - Kai Xu
- Department of Sport and Health Sciences, Nanjing Sport Institute, Nanjing, China
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Guo Z, Liu X, Yang Z, Huang C, Liu J, Liu L, Xu Y, Liu S, Xu D, Chen J. WITHDRAWN: Association between aberrant brain activity and pain in patients with primary osteoporotic pain: a resting-state fMRI study. Neuroscience 2024:S0306-4522(24)00134-9. [PMID: 38521479 DOI: 10.1016/j.neuroscience.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Zhijie Guo
- Department of Acupuncture and Rehabilitation, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xue Liu
- Department of Andrology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhaoxu Yang
- Department of Andrology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Chihuan Huang
- Department of Acupuncture and Rehabilitation, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Jing Liu
- Department of Acupuncture and Rehabilitation, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Lanying Liu
- Department of Acupuncture and Rehabilitation, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Yan Xu
- Department of Andrology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Shaowei Liu
- Department of Radiology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Daoming Xu
- Department of Acupuncture and Rehabilitation, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
| | - Jianhuai Chen
- Department of Andrology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
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Liang HB, He WY, Liu YP, Wang HB. Pain Comorbidities with Attention Deficit: A Narrative Review of Clinical and Preclinical Research. J Pain Res 2024; 17:1055-1065. [PMID: 38505503 PMCID: PMC10948333 DOI: 10.2147/jpr.s443915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 02/23/2024] [Indexed: 03/21/2024] Open
Abstract
A negative correlation exists between attention and pain. The cognitive impairments linked to pain can significantly impede a patient's healing process and everyday tasks, particularly for individuals experiencing persistent pain. Furthermore, it has been demonstrated that diversion can effectively decrease pain levels in individuals. The focus of this review is to analyze clinical trials and fundamental investigations regarding alterations in focus and persistent discomfort. Moreover, we investigated the common neuroanatomy associated with attention and pain. Furthermore, we examined the impact of various neuromodulators on the transmission of pain and processes related to attention, while also considering the potential neural mechanisms that contribute to the co-occurrence of pain and attention deficits. Further investigation in this field will enhance our comprehension of patient symptoms and the underlying pathophysiology, ultimately resulting in more objective approaches to treatment.
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Affiliation(s)
- Hong-Bin Liang
- Graduate School of Guangdong Medical University, Zhanjiang, Guangdong Province, People’s Republic of China
- Department of Anesthesiology, The First People’s Hospital of Foshan, Foshan, Guangdong Province, People’s Republic of China
| | - Wan-You He
- Department of Anesthesiology, The First People’s Hospital of Foshan, Foshan, Guangdong Province, People’s Republic of China
| | - Yan-Ping Liu
- College of Nursing, Shandong First Medical University (Shandong Academy of Medical Science), Jinan, Shandong Province, People’s Republic of China
| | - Han-Bing Wang
- Graduate School of Guangdong Medical University, Zhanjiang, Guangdong Province, People’s Republic of China
- Department of Anesthesiology, The First People’s Hospital of Foshan, Foshan, Guangdong Province, People’s Republic of China
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Costa V, Gianlorenço AC, Pacheco-Barrios K, Fregni F. Brain-heart interactions in fibromyalgia syndrome. PRINCIPLES AND PRACTICE OF CLINICAL RESEARCH (2015) 2024; 9:1-4. [PMID: 38434480 PMCID: PMC10906947 DOI: 10.21801/ppcrj.2023.94.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Affiliation(s)
- Valton Costa
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Laboratory of Neuroscience and Neurological Rehabilitation, Physical Therapy Department, Federal University of Sao Carlos, Sao Carlos, SP, Brazil
| | - Anna Carolyna Gianlorenço
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Laboratory of Neuroscience and Neurological Rehabilitation, Physical Therapy Department, Federal University of Sao Carlos, Sao Carlos, SP, Brazil
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Caumo W, Lopes Ramos R, Vicuña Serrano P, da Silveira Alves CF, Medeiros L, Ramalho L, Tomeddi R, Bruck S, Boher L, Sanches PRS, Silva DP, Ls Torres I, Fregni F. Efficacy of Home-Based Transcranial Direct Current Stimulation Over the Primary Motor Cortex and Dorsolateral Prefrontal Cortex in the Disability Due to Pain in Fibromyalgia: A Factorial Sham-Randomized Clinical Study. THE JOURNAL OF PAIN 2024; 25:376-392. [PMID: 37689323 DOI: 10.1016/j.jpain.2023.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/07/2023] [Accepted: 09/01/2023] [Indexed: 09/11/2023]
Abstract
This randomized, double-blind, controlled clinical trial compared the effectiveness of home-based-(HB) active transcranial direct current stimulation (a-tDCS) over the left dorsolateral prefrontal cortex (l-DLPFC) or primary motor cortex (M1) with their respective sham-(s)-tDCS to determine whether a-tDCS would be more effective than s-tDCS in reducing pain and improving disability due to pain. The study included 102 patients with fibromyalgia aged 30 to 65 years old randomly assigned to 1 of 4 tDCS groups using a ratio of 2:1:2:1. The groups included l-DLPFC (a-tDCS, n = 34) and (s-tDCS, n = 17), or tDCS on the M1 (a-tDCS, n = 34) or (s-tDCS, n = 17). Patients self-administered 20 sessions of tDCS, with 2 mA for 20 minutes each day under remote supervision after in-person training. The Mixed Model for Repeated Measurements revealed that a-tDCS on DLPFC significantly reduced pain scores by 36.53% compared to 25.79% in s-tDCS. From baseline to the fourth week of treatment, a-tDCS on M1 reduced pain scores by 45.89% compared to 22.92% over s-tDCS. A generalized linear model showed a significant improvement in the disability scale in the groups that received a-tDCS compared to s-tDCS over M1 20.54% versus 2.49% (χ2 = 11.06, df = 1, P < .001]), while on DLPFC the improvement was 14.29% and 5.77%, with a borderline significance (χ2 = 3.19, df = 1, P = .06]), respectively. A higher reduction in serum brain-derived neurotrophic factor from baseline to treatment end was positively correlated with decreased pain scores regardless of the treatment group. The application of a-tDCS over M1 increased the heat pain threshold and the function of the descending pain inhibitory system. PERSPECTIVE: These findings provide important insights: (1) HB-tDCS has effectively reduced pain scores and improved disability due to fibromyalgia. (2) The study provides evidence that HB-a-tDCS is a viable and effective therapeutic approach. (3) HB-a-tDCS over M1 improved the function of the descending pain inhibitory system and increased the heat pain threshold. Finally, our findings also emphasize that brain-derived neurotrophic factor, as an index of neuroplasticity, may serve as a valuable marker associated with changes in clinical pain measures. TRIAL REGISTRATION: Number NCT03843203.
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Affiliation(s)
- Wolnei Caumo
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil; Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Pain and Palliative Care Service at HCPA, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil; Department of Surgery, School of Medicine, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rael Lopes Ramos
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Paul Vicuña Serrano
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Camila Fernanda da Silveira Alves
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil; Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Liciane Medeiros
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil; Pain Pharmacology and Neuromodulation Laboratory, Preclinical Investigations, Experimental Research Center, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Postgraduate Program in Health and Human Development, La Salle University, Canoas, Rio Grande do Sul, Brazil
| | - Leticia Ramalho
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Rafalea Tomeddi
- Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Samara Bruck
- Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Lucas Boher
- Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Pain and Palliative Care Service at HCPA, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil; Department of Surgery, School of Medicine, Porto Alegre, Rio Grande do Sul, Brazil
| | - Paulo R S Sanches
- Laboratory of Biomedical Engineer at HCPA, Porto Alegre, Rio Grande do Sul, Brazil
| | - Danton P Silva
- Laboratory of Biomedical Engineer at HCPA, Porto Alegre, Rio Grande do Sul, Brazil
| | - Iraci Ls Torres
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil; Pain Pharmacology and Neuromodulation Laboratory, Preclinical Investigations, Experimental Research Center, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Felipe Fregni
- Laboratory of Neuromodulation and Center for Clinical Research Learning, Physics and Rehabilitation Department, Spaulding Rehabilitation Hospital, Boston, Massachusetts
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Wang S, Du SH, Wang XQ, Lu JY. Mechanisms of transcranial direct current stimulation (tDCS) for pain in patients with fibromyalgia syndrome. Front Mol Neurosci 2024; 17:1269636. [PMID: 38356687 PMCID: PMC10865494 DOI: 10.3389/fnmol.2024.1269636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/10/2024] [Indexed: 02/16/2024] Open
Abstract
Fibromyalgia syndrome (FMS) is a recurrent pain condition that can be challenging to treat. Transcranial direct current stimulation (tDCS) has become a promising non-invasive therapeutic option in alleviating FMS pain, but the mechanisms underlying its effectiveness are not yet fully understood. In this article, we discuss the most current research investigating the analgesic effects of tDCS on FMS and discuss the potential mechanisms. TDCS may exert its analgesic effects by influencing neuronal activity in the brain, altering cortical excitability, changing regional cerebral blood flow, modulating neurotransmission and neuroinflammation, and inducing neuroplasticity. Overall, evidence points to tDCS as a potentially safe and efficient pain relief choice for FMS by multiple underlying mechanisms. This article provides a thorough overview of our ongoing knowledge regarding the mechanisms underlying tDCS and emphasizes the possibility of further studies to improve the clinical utility of tDCS as a pain management tool.
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Affiliation(s)
- Shan Wang
- Department of Health School, Shanghai Normal University Tianhua College, Shanghai, China
| | - Shu-Hao Du
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Xue-Qiang Wang
- Rehabilitation Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- School of Rehabilitation Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Jun-Yan Lu
- Rehabilitation Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- School of Rehabilitation Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
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Azarkolah A, Noorbala AA, Ansari S, Hallajian AH, Salehinejad MA. Efficacy of Transcranial Direct Current Stimulation on Pain Level and Disability of Patients with Fibromyalgia: A Systematic Review of Randomized Controlled Trials with Parallel-Group Design. Brain Sci 2023; 14:26. [PMID: 38248241 PMCID: PMC10813480 DOI: 10.3390/brainsci14010026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/17/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024] Open
Abstract
Transcranial direct current stimulation (tDCS) has been increasingly applied in fibromyalgia (FM) to reduce pain and fatigue. While results are promising, observed effects are variable, and there are questions about optimal stimulation parameters such as target region (e.g., motor vs. prefrontal cortices). This systematic review aimed to provide the latest update on published randomized controlled trials with a parallel-group design to examine the specific effects of active tDCS in reducing pain and disability in FM patients. Using the PRISMA approach, a literature search identified 14 randomized controlled trials investigating the effects of tDCS on pain and fatigue in patients with FM. Assessment of biases shows an overall low-to-moderate risk of bias. tDCS was found effective in all included studies conducted in patients with FM, except one study, in which the improving effects of tDCS were due to placebo. We recommended tDCS over the motor and prefrontal cortices as "effective" and "probably effective" respectively, and also safe for reducing pain perception and fatigue in patients with FM, according to evidence-based guidelines. Stimulation polarity was anodal in all studies, and one single-session study also examined cathodal polarity. The stimulation intensity ranged from 1-mA (7.14% of studies) to 1.5-mA (7.14% of studies) and 2-mA (85.7% of studies). In all of the included studies, a significant improvement in at least one outcome variable (pain or fatigue reduction) was observed. Moreover, 92.8% (13 of 14) applied multi-session tDCS protocols in FM treatment and reported significant improvement in their outcome variables. While tDCS is therapeutically effective for FM, titration studies that systematically evaluate different stimulation intensities, durations, and electrode placement are needed.
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Affiliation(s)
- Anita Azarkolah
- Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran P.O. Box 1416634793, Iran
- Psychosomatic Medicine Research Center, Tehran University of Medical Sciences, Tehran P.O. Box 1416634793, Iran
| | - Ahmad Ali Noorbala
- Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran P.O. Box 1416634793, Iran
- Psychosomatic Medicine Research Center, Tehran University of Medical Sciences, Tehran P.O. Box 1416634793, Iran
| | - Sahar Ansari
- Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran P.O. Box 1416634793, Iran
- Psychosomatic Medicine Research Center, Tehran University of Medical Sciences, Tehran P.O. Box 1416634793, Iran
| | | | - Mohammad Ali Salehinejad
- Department of Psychology and Neurosciences, Leibniz-Institut für Arbeitsforschung, 44139 Dortmund, Germany
- School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran P.O. Box 1956836613, Iran
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Yang S, Enkhzaya G, Zhu BH, Chen J, Wang ZJ, Kim ES, Kim NY. High-Definition Transcranial Direct Current Stimulation in the Right Ventrolateral Prefrontal Cortex Lengthens Sustained Attention in Virtual Reality. Bioengineering (Basel) 2023; 10:721. [PMID: 37370652 DOI: 10.3390/bioengineering10060721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Due to the current limitations of three-dimensional (3D) simulation graphics technology, mind wandering commonly occurs in virtual reality tasks, which has impeded it being applied more extensively. The right ventrolateral prefrontal cortex (rVLPFC) plays a vital role in executing continuous two-dimensional (2D) mental paradigms, and transcranial direct current stimulation (tDCS) over this cortical region has been shown to successfully modulate sustained 2D attention. Accordingly, we further explored the effects of electrical activation of the rVLPFC on 3D attentional tasks using anodal high-definition (HD)-tDCS. A 3D Go/No-go (GNG) task was developed to compare the after effects of real and sham brain stimulation. Specifically, GNG tasks were periodically interrupted to assess the subjective perception of attentional level, behavioral reactions were tracked and decomposed into an underlying decision cognition process, and electroencephalography data were recorded to calculate event-related potentials (ERPs) in rVLPFC. The p-values statistically indicated that HD-tDCS improved the subjective mentality, led to more cautious decisions, and enhanced neuronal discharging in rVLPFC. Additionally, the neurophysiological P300 ERP component and stimulation being active or sham could effectively predict several objective outcomes. These findings indicate that the comprehensive approach including brain stimulation, 3D mental paradigm, and cross-examined performance could significantly lengthen and robustly compare sustained 3D attention.
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Affiliation(s)
- Shan Yang
- RFIC Center, Department of Electronic Engineering, Kwangwoon University, Nonwon-gu, Seoul 01897, Republic of Korea
- NDAC Center, Department of Electronic Engineering, Kwangwoon University, Nonwon-gu, Seoul 01897, Republic of Korea
| | - Ganbold Enkhzaya
- RFIC Center, Department of Electronic Engineering, Kwangwoon University, Nonwon-gu, Seoul 01897, Republic of Korea
- NDAC Center, Department of Electronic Engineering, Kwangwoon University, Nonwon-gu, Seoul 01897, Republic of Korea
| | - Bao-Hua Zhu
- RFIC Center, Department of Electronic Engineering, Kwangwoon University, Nonwon-gu, Seoul 01897, Republic of Korea
| | - Jian Chen
- RFIC Center, Department of Electronic Engineering, Kwangwoon University, Nonwon-gu, Seoul 01897, Republic of Korea
| | - Zhi-Ji Wang
- RFIC Center, Department of Electronic Engineering, Kwangwoon University, Nonwon-gu, Seoul 01897, Republic of Korea
- Department of Pediatrics, Severance Children's Hospital, Yonsei University, Seoul 03722, Republic of Korea
| | - Eun-Seong Kim
- RFIC Center, Department of Electronic Engineering, Kwangwoon University, Nonwon-gu, Seoul 01897, Republic of Korea
| | - Nam-Young Kim
- RFIC Center, Department of Electronic Engineering, Kwangwoon University, Nonwon-gu, Seoul 01897, Republic of Korea
- NDAC Center, Department of Electronic Engineering, Kwangwoon University, Nonwon-gu, Seoul 01897, Republic of Korea
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10
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Teixeira PEP, Pacheco-Barrios K, Branco LC, de Melo PS, Marduy A, Caumo W, Papatheodorou S, Keysor J, Fregni F. The Analgesic Effect of Transcranial Direct Current Stimulation in Fibromyalgia: A Systematic Review, Meta-Analysis, and Meta-Regression of Potential Influencers of Clinical Effect. Neuromodulation 2023; 26:715-727. [PMID: 36435660 PMCID: PMC10203058 DOI: 10.1016/j.neurom.2022.10.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/14/2022] [Accepted: 10/11/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is tentative evidence to support the analgesic effect of transcranial direct current stimulation (tDCS) in fibromyalgia (FM), with large variability in the effect size (ES) encountered in different clinical trials. Understanding the source of the variability and exploring how it relates to the clinical results could characterize effective neuromodulation protocols and ultimately guide care in FM pain. The primary objective of this study was to determine the effect of tDCS in FM pain as compared with sham tDCS. The secondary objective was to explore the relationship of methodology, population, and intervention factors and the analgesic effect of tDCS in FM. MATERIALS AND METHODS For the primary objective, a systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized clinical trials (RCTs) investigating tDCS as an intervention for FM pain were searched in MEDLINE, Embase, and the Web Of Science. Studies were excluded if they used cross-over designs or if they did not use tDCS as an intervention for pain or did not measure clinical pain. Analysis for the main outcome was performed using a random-effects model. Risk of bias and evidence certainty were assessed for all studies using Cochrane Risk of Bias and Grading of Recommendations Assessment, Development, and Evaluation tools. For the secondary objective, a meta-regression was conducted to explore methodology, population, and intervention factors potentially related to the ES. RESULTS Sixteen RCTs were included. Six studies presented a high risk of bias. Significant reduction in pain scores were found for FM (standardized mean difference = 1.22, 95% CI = 0.80-1.65, p < 0.001). Subgroup analysis considering tDCS as a neural target revealed no differences between common neural sites. Meta-regression revealed that the duration of the tDCS protocol in weeks was the only factor associated with the ES, in which protocols that lasted four weeks or longer reported larger ES than shorter protocols. CONCLUSIONS Results suggest an analgesic effect of tDCS in FM. tDCS protocols that last four weeks or more may be associated with larger ESs. Definite conclusions are inadequate given the large heterogeneity and limited quality of evidence of the included studies.
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Affiliation(s)
- Paulo E P Teixeira
- MGH Institute of Health Professions, Boston, MA, USA; Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA; Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Luis Castelo Branco
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Paulo S de Melo
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Anna Marduy
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Wolnei Caumo
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Charlestown, MA, USA; Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Pain and Palliative Care Service at Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Department of Surgery, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Julie Keysor
- MGH Institute of Health Professions, Boston, MA, USA
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA; Harvard T. H. Chan School of Public Health, Boston, MA, USA
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11
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Molero-Chamizo A, Nitsche MA, Barroso RTA, Bailén JRA, Palomeque JCG, Rivera-Urbina GN. Non-Invasive Electric and Magnetic Brain Stimulation for the Treatment of Fibromyalgia. Biomedicines 2023; 11:biomedicines11030954. [PMID: 36979932 PMCID: PMC10046115 DOI: 10.3390/biomedicines11030954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Although fibromyalgia is defined by its core muscular nociceptive component, it also includes multiple dysfunctions that involve the musculoskeletal, gastrointestinal, immune, endocrine, as well as the central and peripheral nervous systems, amongst others. The pathogenic involvement of the nervous system and the numerous neurological and neuroinflammatory symptoms of this disease may benefit from neuromodulatory stimulation techniques that have been shown to be effective and safe in diverse nervous system pathologies. In this systematic review, we outline current evidence showing the potential of non-invasive brain stimulation techniques, such as therapeutic strategies in fibromyalgia. In addition, we evaluate the contribution of these tools to the exploration of the neurophysiological characteristics of fibromyalgia. Considering that the pathogenesis of this disease is unknown, these approaches do not aim to causally treat this syndrome, but to significantly reduce a range of key symptoms and thus improve the quality of life of the patients.
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Affiliation(s)
- Andrés Molero-Chamizo
- Department of Clinical and Experimental Psychology, University of Huelva, Campus El Carmen, 21071 Huelva, Spain
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Center for Working Environment and Human Factors, 44139 Dortmund, Germany
- University Clinic of Psychiatry and Psychotherapy and University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Protestant Hospital of Bethel Foundation, University Hospital OWL, Bielefeld University, 33615 Bielefeld, Germany
| | | | - José R Alameda Bailén
- Department of Clinical and Experimental Psychology, University of Huelva, Campus El Carmen, 21071 Huelva, Spain
| | - Jesús Carlos García Palomeque
- Histology Department, School of Medicine, Cadiz University, 11001 Cádiz, Spain
- Cadiz Bahia Sur District, Andalusian Health Service, 11006 Cádiz, Spain
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12
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Tang X, Jin H, Zou J, Liu S, Li F, Zhou Z. Activation of peroxymonosulfate by catalysts derived from water treatment plant sludge for the simultaneous removal of Disperse Blue 56 and phosphates. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:35683-35697. [PMID: 36538231 DOI: 10.1007/s11356-022-24792-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
In this study, calcined water treatment plant sludge (C-WTPS) was used as a catalyst for peroxymonosulfate (PMS) activation to simultaneously remove Disperse Blue 56 (DB56) and phosphates. Firstly, the performance of the C-WTPS/PMS system was examined for the degradation of DB56. The results showed that 96.7% of DB56 (400 mg L-1) was removed within 60 min in the presence of 4.8 g L-1 PMS and 0.8 g L-1 C-WTPS at pH 3 and 50 °C. Hydroxyl radicals (·OH), sulfate radicals (SO4·-), and singlet oxygen (1O2) were generated during the oxidation process, and 1O2 was the main active species. The relatively high surface area, proper Fe content, and abundant ketone groups on the catalyst surface were responsible for PMS activation. Furthermore, the possible degradation pathways of DB56 were proposed based on the gas chromatography-mass spectrometry (GC-MS) results. Secondly, the simultaneous removal of DB56 and phosphates by the C-WTPS/PMS system was investigated. Due to the different removal mechanisms, the effects of the initial phosphate concentration and water matrix species on the removal of DB56 and phosphates showed different trends. Reusability tests results showed that C-WTPS had relatively high stability. In addition, the C-WTPS/PMS system exhibited a high decolorization ratio and phosphate removal efficiency in real wastewater tests. This article offers a value-added approach for reusing WTPS as a catalyst for treating organic contaminants and phosphates.
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Affiliation(s)
- Xing Tang
- College of Civil Engineering, Huaqiao University, Jimei Avenue 668, Xiamen, 361021, Jimei District, China
| | - Hongyi Jin
- College of Civil Engineering, Huaqiao University, Jimei Avenue 668, Xiamen, 361021, Jimei District, China
| | - Jing Zou
- College of Civil Engineering, Huaqiao University, Jimei Avenue 668, Xiamen, 361021, Jimei District, China
| | - Shupo Liu
- College of Civil Engineering, Huaqiao University, Jimei Avenue 668, Xiamen, 361021, Jimei District, China
| | - Fei Li
- College of Civil Engineering, Huaqiao University, Jimei Avenue 668, Xiamen, 361021, Jimei District, China
| | - Zhenming Zhou
- College of Civil Engineering, Huaqiao University, Jimei Avenue 668, Xiamen, 361021, Jimei District, China.
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13
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Transcranial random noise stimulation over the left dorsolateral prefrontal cortex attenuates pain expectation and perception. Clin Neurophysiol 2023; 147:1-10. [PMID: 36608385 DOI: 10.1016/j.clinph.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/04/2022] [Accepted: 12/14/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The dorsolateral prefrontal cortex (DLPFC) has been increasingly used as a neuromodulatory target in pain management. Transcranial random noise stimulation (tRNS) was shown to effectively elevate cortical excitability. Hence, this study aimed to characterize how tRNS over the left DLPFC affects pain expectation and perception, as well as the efficacy of conditioned-pain modulation (CPM) that reflects the function of the endogenous pain-inhibitory pathway. METHODS Using a randomized, double-blinded, and sham-controlled design, healthy participants were randomly recruited to receive tRNS with a direct current offset or sham stimulation. Their expectations and perceptions of painful electrocutaneous stimuli, as well as CPM efficacy were assessed before, immediately after, and 30 min after tRNS. RESULTS Compared with sham stimulation, perceived-pain ratings to the painful stimuli, and expected-pain ratings before painful stimuli, attenuated immediately after tRNS, whereas this analgesic effect was ineffective 30 min after tRNS. Importantly, the immediate analgesia induced by tRNS could be accounted for by tRNS effect on attenuating expected-pain ratings before certain painful stimuli. However, CPM efficacy was not significantly affected by tRNS. CONCLUSIONS These results demonstrate analgesia immediately after applying tRNS over the left DLPFC. SIGNIFICANCE This study provides evidence for analgesia of DLPFC-tRNS on an experimental pain model.
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14
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Schein B, Beltran G, França BR, Sanches PRS, Silva Jr DP, Torres IL, Fegni F, Caumo W. Effects of Hypnotic Analgesia and Transcranial Direct Current Stimulation on Pain Tolerance and Corticospinal Excitability in Individuals with Fibromyalgia: A Cross-Over Randomized Clinical Trial. J Pain Res 2023; 16:187-203. [PMID: 36718400 PMCID: PMC9884000 DOI: 10.2147/jpr.s384373] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/28/2022] [Indexed: 01/24/2023] Open
Abstract
Objective We compare the effect of HAS, a-tDCS on the left dorsolateral prefrontal cortex (l-DLPFC), and rest-testing on pain measures [(cold pressor test (CPT) (primary outcome) and heat pain threshold]. We also compare their effects on the motor evoked potential (MEP) (primary outcome), short intracortical inhibition (SICI), intracortical facilitation (ICF), and cortical silent period (CSP). Methods This randomized, blind, crossover trial included 18 women with fibromyalgia, aged from 18 to 65 years old. They received at random and in a crossover order a-tDCS over the l-DLPFC (2mA), HAS, or a rest-testing. Results HAS compared to a-tDCS increased the pain tolerance with a moderate effect size (ES) [Cohen's f=-0.78; (CI 95%; -1.48 to -0.12)]. While compared to rest-testing, HAS increased the CPT with a large ES [Cohen's f=-0.87; (CI 95%; -1.84 to -0.09)]. The a-tDCS compared to HAS increased the MEP amplitude with large ES [Cohen's f=-1.73 (CI 95%; -2.17 to -0.17)]. Likewise, its ES compared to rest-testing in the MEP size was large [Cohen's f=-1.03; (CI 95%; -2.06 to -0.08)]. Conclusion These findings revealed that HAS affects contra-regulating mechanisms involved in perception and pain tolerance, while the a-tDCS increased the excitability of the corticospinal pathways. They give a subsidy to investigate their effect as approaches to counter regulate the maladaptive neuroplasticity involved in fibromyalgia. Clinical Trial Registration www.ClinicalTrials.gov, identifier - NCT05066568.
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Affiliation(s)
- Bruno Schein
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul (RS), Brazil,Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Gerardo Beltran
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul (RS), Brazil,Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil,Institute of Neurosciences, Universidad Catolica de Cuenca, Cuenca, Ecuador
| | - Bárbara Regina França
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul (RS), Brazil,Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | | | | | - Iraci Lucena Torres
- Pain and Palliative Care Service, HCPA, Porto Alegre, RS, Brazil,Laboratory of Pharmacology of Pain and Neuromodulation, Experimental Research Center, HCPA, Porto Alegre, RS, Brazil
| | - Felipe Fegni
- Laboratory of Neuromodulation and Center for Clinical Research Learning, Physics and Rehabilitation Department, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Wolnei Caumo
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul (RS), Brazil,Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil,Pain and Palliative Care Service, HCPA, Porto Alegre, RS, Brazil,Department of Surgery, School of Medicine, UFRGS, Porto Alegre, RS, Brazil,Correspondence: Wolnei Caumo, Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre at UFRGS, Ramiro Barcelos, 2350 - CEP 90035-003 Bairro Rio Branco, Porto Alegre, RS, Brazil, Tel/Fax +55 51- 33598083, Email
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15
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Loreti EH, Freire AM, Alexandre da Silva A, Kakuta E, Martins Neto UR, Konkiewitz EC. Effects of Anodal Transcranial Direct Current Stimulation on the Primary Motor Cortex in Women With Fibromyalgia: A Randomized, Triple-Blind Clinical Trial. Neuromodulation 2023:S1094-7159(22)01370-8. [PMID: 36702675 DOI: 10.1016/j.neurom.2022.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/08/2022] [Accepted: 11/14/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The aim of this study was to analyze the effects of ten sessions of active transcranial direct current stimulation transcranial direct current stimulation (tDCS) (2 mA) with 13:20:13 stimulation at M1 in women with fibromyalgia (FM). To the best of our knowledge, this is the first article that uses this protocol in patients with FM. The main hypothesis is that the protocol would be effective in decreasing pain and that the results would last for up to 90 days. MATERIALS AND METHODS This study was a randomized clinical trial with 35 women with FM divided into two groups, active tDCS group and sham tDCS group. A conventional tDCS device was used to deliver 2 mA for 13 minutes, with a 20-minute break followed by a further 13 minutes of stimulation for ten sessions. The anodal stimulus was in the left primary motor cortex M1 region. The primary outcome was a change in the visual analog scale and the Survey of Pain Attitudes pain score at the end of treatment, after 30 days, and 90 days after the end of treatment. Secondary outcomes included changes in the Fibromyalgia Impact Questionnaire, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, World Health Organization's Quality of Life Questionnaire, and Fatigue Assessment Scale. The Research Ethics Committee of the Centro Universitário da Grande Dourados under registration number Certificado de Apresentação de Apreciação Ética approved this research: 36444920.5.0000.5159. The study was registered in The Brazilian Registry of Clinical Trials with the identifier RBR-8wc8rjq. RESULTS The active tDCS group showed improvement in pain after ten sessions (p < 0.001), after 30 days (p < 0.01), and after 90 days (p < 0.001) compared with sham tDCS. In addition, improvement in quality of life (QoL) and fatigue was observed in the active tDCS group. CONCLUSION The results of this study suggest that active tDCS with an intensity of 2 mA for ten sessions was effective in decreasing pain and fatigue and improving QoL in patients with FM.
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Affiliation(s)
| | - Ariana Mendes Freire
- Department of Physiotherapy, Grande Dourados University Center, Dourados, Brazil
| | | | - Elaine Kakuta
- Department of Health Sciences, Federal University of Grande Dourados, Dourados, Brazil
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16
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Development of a Clinical Prediction Rule for Treatment Success with Transcranial Direct Current Stimulation for Knee Osteoarthritis Pain: A Secondary Analysis of a Double-Blind Randomized Controlled Trial. Biomedicines 2022; 11:biomedicines11010004. [PMID: 36672512 PMCID: PMC9855334 DOI: 10.3390/biomedicines11010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
The study’s objective was to develop a clinical prediction rule that predicts a clinically significant analgesic effect on chronic knee osteoarthritis pain after transcranial direct current stimulation treatment. This is a secondary analysis from a double-blind randomized controlled trial. Data from 51 individuals with chronic knee osteoarthritis pain and an impaired descending pain inhibitory system were used. The intervention comprised a 15-session protocol of anodal primary motor cortex transcranial direct current stimulation. Treatment success was defined by the Western Ontario and McMaster Universities’ Osteoarthritis Index pain subscale. Accuracy statistics were calculated for each potential predictor and for the final model. The final logistic regression model was statistically significant (p < 0.01) and comprised five physical and psychosocial predictor variables that together yielded a positive likelihood ratio of 14.40 (95% CI: 3.66−56.69) and an 85% (95%CI: 60−96%) post-test probability of success. This is the first clinical prediction rule proposed for transcranial direct current stimulation in patients with chronic pain. The model underscores the importance of both physical and psychosocial factors as predictors of the analgesic response to transcranial direct current stimulation treatment. Validation of the proposed clinical prediction rule should be performed in other datasets.
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17
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Serrano PV, Zortea M, Alves RL, Beltrán G, Bavaresco C, Ramalho L, Alves CFDS, Medeiros L, Sanches PRS, Silva DP, Lucena da Silva Torres I, Fregni F, Caumo W. The effect of home-based transcranial direct current stimulation in cognitive performance in fibromyalgia: A randomized, double-blind sham-controlled trial. Front Hum Neurosci 2022; 16:992742. [PMID: 36504629 PMCID: PMC9730884 DOI: 10.3389/fnhum.2022.992742] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/22/2022] [Indexed: 11/26/2022] Open
Abstract
Background Transcranial Direct Current Stimulation (tDCS) is a promising approach to improving fibromyalgia (FM) symptoms, including cognitive impairment. So, we evaluated the efficacy and safety of home-based tDCS in treating cognitive impairment. Besides, we explored if the severity of dysfunction of the Descendant Pain Modulation System (DPMS) predicts the tDCS effect and if its effect is linked to changes in neuroplasticity as measured by the brain-derived neurotrophic factor (BDNF). Methods This randomized, double-blind, parallel, sham-controlled clinical trial, single-center, included 36 women with FM, aged from 30 to 65 years old, assigned 2:1 to receive a-tDCS (n = 24) and s-tDCS (n = 12). The primary outcome was the Trail Making Test's assessment of executive attention, divided attention, working memory (WM), and cognitive flexibility (TMT-B-A). The secondary outcomes were the Controlled Oral Word Association Test (COWAT), the WM by Digits subtest from the Wechsler Adult Intelligence Scale (WAIS-III), and quality of life. Twenty-minute daily sessions of home-based tDCS for 4 weeks (total of 20 sessions), 2 mA anodal-left (F3) and cathodal-right (F4) prefrontal stimulation with 35 cm2 carbon electrodes. Results GLM showed a main effect for treatment in the TMT-B-A [Wald χ2 = 6.176; Df = 1; P = 0.03]. The a-tDCS improved cognitive performance. The effect size estimated by Cohen's d at treatment end in the TMT-B-A scores was large [-1.48, confidence interval (CI) 95% = -2.07 to-0.90]. Likewise, the a-tDCS effects compared to s-tDCS improved performance in the WM, verbal and phonemic fluency, and quality-of-life scale. The impact of a-tDCS on the cognitive tests was positively correlated with the reduction in serum BDNF from baseline to treatment end. Besides, the decrease in the serum BDNF was positively associated with improving the quality of life due to FM symptoms. Conclusion These findings revealed that daily treatment with a home-based tDCS device over l-DLPFC compared to sham stimulation over 4 weeks improved the cognitive impairment in FM. The a-tDCS at home was well-tolerated, underlining its potential as an alternative treatment for cognitive dysfunction. Besides, the a-tDCS effect is related to the severity of DPMS dysfunction and changes in neuroplasticity state. Clinical trial registration [www.ClinicalTrials.gov], identifier [NCT03843203].
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Affiliation(s)
- Paul Vicuña Serrano
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil,Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Maxciel Zortea
- Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil,Centro Universitário Cesuca, Cachoeirinha, Brazil
| | - Rael Lopes Alves
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil,Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Gerardo Beltrán
- Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil,Institute of Neurosciences of the Universidad Catolica de Cuenca, UCACUE, Cuenca, Ecuador
| | - Cibely Bavaresco
- Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Leticia Ramalho
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil,Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Camila Fernanda da Silveira Alves
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil,Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Liciane Medeiros
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil,Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil,Programa de Pós-Graduação em Saúde e Desenvolvimento Humano, Universidade La Salle, Canoas, Brazil
| | | | - Danton P. Silva
- Laboratory of Biomedical Engineer at HCPA, Porto Alegre, Brazil
| | - Iraci Lucena da Silva Torres
- Pain and Palliative Care Service at HCPA, Porto Alegre, Brazil,Laboratorio de Farmacologia da Dor e Neuromodulação: Investigacoes Pre-clinicas, Centro de Pesquisa Experimental (CPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Felipe Fregni
- Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil,Laboratory of Neuromodulation, Department of Physics and Rehabilitation, Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Wolnei Caumo
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil,Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil,Pain and Palliative Care Service at HCPA, Porto Alegre, Brazil,Laboratory of Neuromodulation, Department of Physics and Rehabilitation, Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Boston, MA, United States,Department of Surgery, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil,School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil,*Correspondence: Wolnei Caumo,
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Alcon CA, Wang-Price S. Non-invasive brain stimulation and pain neuroscience education in the cognitive-affective treatment of chronic low back pain: Evidence and future directions. FRONTIERS IN PAIN RESEARCH 2022; 3:959609. [PMID: 36438443 PMCID: PMC9686004 DOI: 10.3389/fpain.2022.959609] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/24/2022] [Indexed: 11/12/2022] Open
Abstract
Chronic low back pain (CLBP) is among the leading causes of disability worldwide. Beyond the physical and functional limitations, people's beliefs, cognitions, and perceptions of their pain can negatively influence their prognosis. Altered cognitive and affective behaviors, such as pain catastrophizing and kinesiophobia, are correlated with changes in the brain and share a dynamic and bidirectional relationship. Similarly, in the presence of persistent pain, attentional control mechanisms, which serve to organize relevant task information are impaired. These deficits demonstrate that pain may be a predominant focus of attentional resources, leaving limited reserve for other cognitively demanding tasks. Cognitive dysfunction may limit one's capacity to evaluate, interpret, and revise the maladaptive thoughts and behaviors associated with catastrophizing and fear. As such, interventions targeting the brain and resultant behaviors are compelling. Pain neuroscience education (PNE), a cognitive intervention used to reconceptualize a person's pain experiences, has been shown to reduce the effects of pain catastrophizing and kinesiophobia. However, cognitive deficits associated with chronic pain may impact the efficacy of such interventions. Non-invasive brain stimulation (NIBS), such as transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS) has been shown to be effective in the treatment of anxiety, depression, and pain. In addition, as with the treatment of most physical and psychological diagnoses, an active multimodal approach is considered to be optimal. Therefore, combining the neuromodulatory effects of NIBS with a cognitive intervention such as PNE could be promising. This review highlights the cognitive-affective deficits associated with CLBP while focusing on current evidence for cognition-based therapies and NIBS.
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Affiliation(s)
- Cory A. Alcon
- Department of Physical Therapy, High Point University, High Point, NC, United States
- School of Physical Therapy, Texas Woman’s University, Dallas, TX, United States
- Correspondence: Cory A. Alcon
| | - Sharon Wang-Price
- School of Physical Therapy, Texas Woman’s University, Dallas, TX, United States
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Leite J, Gonçalves ÓF, Carvalho S. Speed of Processing (SoP) Training Plus α-tACS in People With Mild Cognitive Impairment: A Double Blind, Parallel, Placebo Controlled Trial Study Protocol. Front Aging Neurosci 2022; 14:880510. [PMID: 35928993 PMCID: PMC9344129 DOI: 10.3389/fnagi.2022.880510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
Several cognitive training programs, alone or in combination with non-invasive brain stimulation have been tested in order to ameliorate age-related cognitive impairments, such as the ones found in Mild Cognitive Impairment (MCI). However, the effects of Cognitive Training (CT)—combined or not—with several forms of non-invasive brain stimulation have been modest at most. We aim to assess if Speed of Processing (SoP) training combined with alpha transcranial alternating current stimulation (α-tACS) is able to increase speed of processing as assessed by the Useful Field of View (UFOV), when comparing to SoP training or active α-tACS alone. Moreover, we want to assess if those changes in speed of processing transfer to other cognitive domains, such as memory, language and executive functioning by using the NIH EXAMINER. We also want to test the mechanisms underlying these interventions, namely brain connectivity and coherence as assessed by electroencephalography (EEG). To that purpose, our proposal is to enroll 327 elders diagnosed with MCI in a double-blinded, parallel randomized clinical trial assessing the effects of combining SoP with alpha endogenous tACS (either active or sham) in people with MCI. Participants will perform an intervention that will last for 15 sessions. For the first 3 weeks, participants will receive nine sessions of the intervention, and then will receive two sessions per week (i.e., booster) for the following 3 weeks. They will then be assessed at 1, 3, and 6 months after the intervention has ended. This will allow us to detect the immediate, and long-term effects of the interventions, as well as to probe the mechanisms underlying its effects.Clinical Trial Registration:Clinicaltrials.gov, Identifier: NCT05198726.
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Affiliation(s)
- Jorge Leite
- Portucalense Institute for Human Development—INPP, Portucalense University, Porto, Portugal
- Portuguese Network for the Psychological Neuroscience, Portugal
- *Correspondence: Jorge Leite
| | - Óscar F. Gonçalves
- Portuguese Network for the Psychological Neuroscience, Portugal
- Proaction Laboratory, CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Sandra Carvalho
- Portuguese Network for the Psychological Neuroscience, Portugal
- Department of Education and Psychology and William James Center for Research, University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal
- The Psychology Research Centre (CIPsi), School of Psychology, University of Minho, Braga, Portugal
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Gan T, Huang Y, Hao X, Hu L, Zheng Y, Yang Z. Anodal tDCS Over the Left Frontal Eye Field Improves Sustained Visual Search Performance. Perception 2022; 51:263-275. [PMID: 35275023 DOI: 10.1177/03010066221086446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Monotonous and repetitive tasks cause vigilance, or sustained attention decrement, which possibly leads to irreparable accident consequences in the aerospace and nuclear industry. Buffering the decrement of vigilance in visual search tasks is essential for cognitive enhancement and ergonomic research. This study aimed to evaluate the efficacy of anodal transcranial direct current stimulation (tDCS) applied to the left frontal eye field (FEF) to improve the performance of the sustained visual search. Twenty-seven healthy participants received anodal and sham tDCS of 2 mA for 28.8 min and completed a visual search task lasting for approximately 40 min without any break. For the online effect, results showed that the d' hit rate and accuracy under anodal tDCS were significantly higher than those under sham conditions during 0-19.2 min time intervals. For the after-effect, compared with sham, anodal tDCS caused significantly higher d' in the 10 min after completing the tDCS. Our findings suggest that anodal tDCS over the left FEF could effectively mitigate the decline of visual vigilance performance by buffering cognitive resource depletion.
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Affiliation(s)
- Tian Gan
- 12646Department of Psychology, Zhejiang Sci-Tech University, Hangzhou, China
| | - Yanyan Huang
- 12646Department of Psychology, Zhejiang Sci-Tech University, Hangzhou, China
| | - Xin Hao
- 12646Department of Psychology, Zhejiang Sci-Tech University, Hangzhou, China
| | - Lina Hu
- 12646Department of Psychology, Zhejiang Sci-Tech University, Hangzhou, China
| | - Yan Zheng
- 12646Department of Psychology, Zhejiang Sci-Tech University, Hangzhou, China
| | - Zhen Yang
- 12646Department of Psychology, Zhejiang Sci-Tech University, Hangzhou, China
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21
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Kim S, Salazar Fajardo JC, Seo E, Gao C, Kim R, Yoon B. Effects of transcranial direct current stimulation on physical and mental health in older adults with chronic musculoskeletal pain: a randomized controlled trial. Eur Geriatr Med 2022; 13:959-966. [PMID: 35230676 PMCID: PMC8886191 DOI: 10.1007/s41999-022-00626-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/09/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE We investigated the effects of transcranial direct current stimulation (tDCS) combined with physical therapy (PT) on pain levels, physical activity levels, quality of life, and depression in older adults with chronic musculoskeletal pain. METHODS Twenty-five older adults (9 males and 16 females), aged between 66 and 86 years (active group 77.2 ± 3.9; sham group 76.6 ± 6.2), volunteers were randomly allocated in the active (active tDCS + PT) and sham groups (sham tDCS + PT), and received the intervention three times per week for 8 weeks. Pain level, physical activity level, depression state, and quality of life were assessed based on the Visual Analog Scale (VAS), Physical Activity Scale for the Elderly (PASE), Beck Depression Inventory (BDI) scale, and Short-Form 36 Health Survey Questionnaire (SF-36), respectively. Measurements were conducted four times: at baseline, mid-intervention, post-intervention, and 1-month follow-up. RESULTS As a result, at 8 weeks, the active group yielded greater improvements in VAS, BDI, and SF-36 scores than the sham tDCS group. At follow-up, the tDCS group led to a greater improvement in VAS, PASE, and SF-36 scores compared to sham tDCS group (p < 0.05). CONCLUSION Our results suggest a beneficial effect of tDCS combined with PT in older adults with chronic musculoskeletal pain in the reduction of pain sensation, increment of physical activity level, increment of the quality of life, and reduction of depression incidents. This opens the possibility the possibility of using tDCS as a regular treatment for this population's physical and mental health.
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Affiliation(s)
- Seungmin Kim
- Major of Rehabilitation Science, Graduate School, College of Health Science, Korea University, Hana Science Hall, Anam-dong-5-ga, Sungbuk-Gu, Seoul, 136-703, Republic of Korea
- Department of Health Sciences, Graduate School, Korea University, Seoul, Korea
| | - Jhosedyn Carolaym Salazar Fajardo
- Major of Rehabilitation Science, Graduate School, College of Health Science, Korea University, Hana Science Hall, Anam-dong-5-ga, Sungbuk-Gu, Seoul, 136-703, Republic of Korea
- Department of Health Sciences, Graduate School, Korea University, Seoul, Korea
| | - Eunyoung Seo
- Major of Rehabilitation Science, Graduate School, College of Health Science, Korea University, Hana Science Hall, Anam-dong-5-ga, Sungbuk-Gu, Seoul, 136-703, Republic of Korea
- Department of Health Sciences, Graduate School, Korea University, Seoul, Korea
- BK21FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Korea
| | - Chang Gao
- Major of Rehabilitation Science, Graduate School, College of Health Science, Korea University, Hana Science Hall, Anam-dong-5-ga, Sungbuk-Gu, Seoul, 136-703, Republic of Korea
- Department of Health Sciences, Graduate School, Korea University, Seoul, Korea
- BK21FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Korea
| | - Rockhyun Kim
- Major of Rehabilitation Science, Graduate School, College of Health Science, Korea University, Hana Science Hall, Anam-dong-5-ga, Sungbuk-Gu, Seoul, 136-703, Republic of Korea
- Department of Health Sciences, Graduate School, Korea University, Seoul, Korea
- BK21FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Korea
| | - BumChul Yoon
- Major of Rehabilitation Science, Graduate School, College of Health Science, Korea University, Hana Science Hall, Anam-dong-5-ga, Sungbuk-Gu, Seoul, 136-703, Republic of Korea.
- Department of Health Sciences, Graduate School, Korea University, Seoul, Korea.
- BK21FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Korea.
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22
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Coussement C, De Longueville X, Heeren A. Attentional networks in co-occurring generalized anxiety disorder and major depression disorder: Towards a staging approach to the executive control deficits. Compr Psychiatry 2022; 113:152294. [PMID: 34942482 DOI: 10.1016/j.comppsych.2021.152294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/29/2021] [Accepted: 12/17/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Major Depression Disorder (MDD) and Generalized Anxiety Disorder (GAD) often co-occur, but the neurocognitive mechanisms of this co-occurrence remain unknown. Prominent views have pointed to attentional processes as potent mechanisms at play in MDD and GAD, respectively. Yet uncertainty remains regarding the very nature of attentional impairments in patients with co-occurring MDD and GAD. METHODS Inspired by contemporary models of attentional networks, we compared the three main attentional networks, namely the orienting, alerting, and executive networks of the Attention Network Task's model, in four groups of patients with, respectively, co-occurring DSM-5 MDD and GAD (n = 30), DSM-5 MDD only (n = 30), DSM-5 GAD only (n = 30), or free from any DSM-5 diagnosis (n = 30). To capture the multivariate nature of our data, we examined between-group differences in the attentional networks through a multivariate analysis of variance. RESULTS Patients with co-occurring MDD and GAD exhibited more severe impairments in the executive control network than those with only one of the disorders. Although patients with MDD or GAD solely did not differ in terms of attentional impairments, both groups showed significantly more impairments in the executive control network than those free from any DSM-5 diagnosis (all Bonferonni-corrected post-hoc ps < 0.05). CONCLUSIONS Our findings align with a longstanding staging approach to comorbidity whereby, via synergistic effects, co-occurring disorders produce more damages than the sum of each disorder. Here, for the first time, we extended this approach to the executive network of attention in the context of the co-occurrence between MDD and GAD.
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Affiliation(s)
- Charlotte Coussement
- Psychological Sciences Research Institute, UCLouvain, Belgium; Le Beau Vallon - Psychiatric Hospital, Belgium
| | - Xavier De Longueville
- Department of Adult Psychiatry, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Alexandre Heeren
- Psychological Sciences Research Institute, UCLouvain, Belgium; Institute of Neuroscience, UCLouvain, Belgium.
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23
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Ibraheem W, Mckenzie S, Wilcox-Omubo V, Abdelaty M, Saji SE, Siby R, Alalyani W, Mostafa JA. Pathophysiology and Clinical Implications of Cognitive Dysfunction in Fibromyalgia. Cureus 2021; 13:e19123. [PMID: 34858761 PMCID: PMC8614169 DOI: 10.7759/cureus.19123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/29/2021] [Indexed: 11/24/2022] Open
Abstract
Cognitive dysfunction is a complaint of many patients diagnosed with fibromyalgia. Although the main symptoms of the disease are fatigue, widespread musculoskeletal pain, poor sleep quality, and tenderness points, the cognitive symptoms can be more distressing than the pain itself, and negatively affect their lives; however, many healthcare professionals underestimate these cognitive complaints and it is still one of the least researched topics. Proper management of these symptoms at an early stage may have a great impact to improve the mental health, physical function, and overall health of these patients. Hence, this traditional review aimed to look at the previous body of literature in PubMed in the past five years to address the pathophysiology of the cognitive dysfunction in fibromyalgia patients, to find the risk factors of cognitive dysfunction in these patients, to discover the recent modalities for treatment, and to figure out the clinical implications and recent recommendations by researchers on screening, diagnosis, and management of fibromyalgia and its cognitive dysfunction symptoms. This review has shown the various mechanisms of cognitive dysfunction. Some mechanisms are related to disease symptomologies, such as excessive pain perception, and others are related to hormonal and metabolite changes in the brain. Tobacco smoking and high body mass index showed an inverse impact on cognitive dysfunction and quality of life in fibromyalgia. Other risk factors and clinical implications were discussed in detail.
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Affiliation(s)
- Weaam Ibraheem
- Medical Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Simon Mckenzie
- Medical Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Victory Wilcox-Omubo
- Medical Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mohamed Abdelaty
- Medical Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sandra E Saji
- Medical Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Rosemary Siby
- Medical Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Wafaa Alalyani
- Medical Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Jihan A Mostafa
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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24
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Caumo W, Alves RL, Vicuña P, Alves CFDS, Ramalho L, Sanches PRS, Silva DP, Torres ILDS, Fregni F. Impact of bifrontal home-based transcranial direct current stimulation in pain catastrophizing and disability due to pain in fibromyalgia: a randomized, double-blind sham-controlled study. THE JOURNAL OF PAIN 2021; 23:641-656. [PMID: 34785366 DOI: 10.1016/j.jpain.2021.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 09/05/2021] [Accepted: 11/08/2021] [Indexed: 11/15/2022]
Abstract
This randomized, double-blind trial tested the hypothesis that twenty sessions of home-based anodal(a)-transcranial direct current stimulation (tDCS) (2mA for 20 min) bifrontal, with anodal on the left dorsolateral prefrontal cortex (l-DLPFC) would be better than sham-(s)-tDCS to reduce scores on Pain Catastrophizing Scale (PCS) and disability-related to pain (DRP) assessed by the Profile of Chronic Pain: Screen (PCP:S) (primary outcomes). Secondary outcomes were depressive symptoms, sleep quality, heat pain threshold (HPT), heat pain tolerance (HPTo), and serum brain-derived-neurotrophic-factor (BDNF). Forty-eight women with fibromyalgia, 30-65 years-old were randomized into 2:1 groups [a-tDCS (n=32) or s-tDCS (n=16)]. Post hoc analysis revealed that a-tDCS reduced the PCS total scores by 51.38% compared to 26.96% in s-tDCS, and a-tDCS reduced PCP:S total scores by 31.43% compared to 19.15% in s-tDCS. The a-tDCS improved depressive symptoms, sleep quality and increased the HPTo. The delta-value in the serum BDNF (mean post treatment end minus pre-treatment) was conversely correlated with the a-tDCS effect in pain catastrophizing. In contrast, the a-tDCS impact on reducing the DRP at the treatment end was positively associated with a reduction in the serum BDNF and improvement of depressive symptoms, sleep quality and pain catastrophizing symptoms. PERSPECTIVE: Home-based bifrontal tDCS with a-tDCS on the l-DLPFC are associated with a moderate effect size (ES) in the following outcomes: (i) Decreased rumination and magnification of pain catastrophizing. (ii) Improved the disability for daily activities due to fibromyalgia symptoms. Overall, these findings support the feasibility of self-applied home-based tDCS on DLPFC to improve fibromyalgia symptoms.
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Affiliation(s)
- Wolnei Caumo
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Laboratory of Neuromodulation and Center for Clinical Research Learning, Physics and Rehabilitation Department, Spaulding Rehabilitation Hospital, Boston, MA, USA; Pain and Palliative Care Service at HCPA, Brazil; Department of Surgery, School of Medicine, UFRGS, Brazil.
| | - Rael Lopes Alves
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
| | - Paul Vicuña
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
| | - Camila Fernanda da Silveira Alves
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
| | - Leticia Ramalho
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
| | | | | | | | - Felipe Fregni
- Laboratory of Neuromodulation and Center for Clinical Research Learning, Physics and Rehabilitation Department, Spaulding Rehabilitation Hospital, Boston, MA, USA; School of Medicine, UFRGS; Laboratorio de Farmacologia da Dor e Neuromodulação: Investigacoes Pre-clinicas, Centro de Pesquisa Experimental (CPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
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25
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Arroyo-Fernández R, Avendaño-Coy J, Velasco-Velasco R, Palomo-Carrión R, Bravo-Esteban E, Ferri-Morales A. A New Approach to Assess Blinding for Transcranial Direct Current Stimulation Treatment in Patients with Fibromyalgia. A Randomized Clinical Trial. Brain Sci 2021; 11:brainsci11101335. [PMID: 34679399 PMCID: PMC8533681 DOI: 10.3390/brainsci11101335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/03/2021] [Accepted: 10/06/2021] [Indexed: 12/03/2022] Open
Abstract
Correct blinding is essential for preventing potential biases. The aim of this study was to assess the blinding of participants and a therapist following treatment with transcranial direct current stimulation in subjects with fibromyalgia using James’ and Bang’s blinding indexes. Eighty subjects were randomly allocated either active or sham stimulation groups in an intervention of five sessions lasting 20 min each. A questionnaire was delivered to both the therapist and patients after the last session to record their guess of which treatment had been applied. No differences between the groups were noted at baseline in terms of demographic or clinical data. James’ BI was 0.83 (CI 95%: 0.76–0.90) for the patients and 0.55 (CI 95%: 0.45–0.64) for the therapist. Bang’s BI for subjects was −0.08 (CI 95%: −0.24–0.09) and −0.8 (CI 95%: −0.26–0.1) for the active and sham transcranial direct current stimulation groups, respectively. Bang’s BI for the therapist was 0.21 (CI 95%: −0.02–0.43) and 0.13 (CI 95%: −0.09–0.35) for the active and sham transcranial direct current stimulation groups, respectively. Protocols of active and sham transcranial direct current stimulation applied in this study have shown satisfactory blinding of the therapist and subjects with fibromyalgia.
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Affiliation(s)
- Rubén Arroyo-Fernández
- Physiotherapy Unit, Nª Sª del Prado Hospital, 45600 Talavera de la Reina, Spain;
- Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, 45071 Toledo, Spain; (R.V.-V.); (R.P.-C.); (E.B.-E.); (A.F.-M.)
- Toledo Physiotherapy Research Group (GIFTO), 45071 Toledo, Spain
| | - Juan Avendaño-Coy
- Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, 45071 Toledo, Spain; (R.V.-V.); (R.P.-C.); (E.B.-E.); (A.F.-M.)
- Toledo Physiotherapy Research Group (GIFTO), 45071 Toledo, Spain
- Correspondence:
| | - Rafael Velasco-Velasco
- Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, 45071 Toledo, Spain; (R.V.-V.); (R.P.-C.); (E.B.-E.); (A.F.-M.)
| | - Rocío Palomo-Carrión
- Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, 45071 Toledo, Spain; (R.V.-V.); (R.P.-C.); (E.B.-E.); (A.F.-M.)
- Toledo Physiotherapy Research Group (GIFTO), 45071 Toledo, Spain
| | - Elisabeth Bravo-Esteban
- Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, 45071 Toledo, Spain; (R.V.-V.); (R.P.-C.); (E.B.-E.); (A.F.-M.)
- Toledo Physiotherapy Research Group (GIFTO), 45071 Toledo, Spain
| | - Asunción Ferri-Morales
- Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, 45071 Toledo, Spain; (R.V.-V.); (R.P.-C.); (E.B.-E.); (A.F.-M.)
- Health and Social Research Center, University of Castilla-La Mancha, Camino de Pozuelo, 16071 Cuenca, Spain
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26
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Kandić M, Moliadze V, Andoh J, Flor H, Nees F. Brain Circuits Involved in the Development of Chronic Musculoskeletal Pain: Evidence From Non-invasive Brain Stimulation. Front Neurol 2021; 12:732034. [PMID: 34531819 PMCID: PMC8438114 DOI: 10.3389/fneur.2021.732034] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/06/2021] [Indexed: 12/03/2022] Open
Abstract
It has been well-documented that the brain changes in states of chronic pain. Less is known about changes in the brain that predict the transition from acute to chronic pain. Evidence from neuroimaging studies suggests a shift from brain regions involved in nociceptive processing to corticostriatal brain regions that are instrumental in the processing of reward and emotional learning in the transition to the chronic state. In addition, dysfunction in descending pain modulatory circuits encompassing the periaqueductal gray and the rostral anterior cingulate cortex may also be a key risk factor for pain chronicity. Although longitudinal imaging studies have revealed potential predictors of pain chronicity, their causal role has not yet been determined. Here we review evidence from studies that involve non-invasive brain stimulation to elucidate to what extent they may help to elucidate the brain circuits involved in pain chronicity. Especially, we focus on studies using non-invasive brain stimulation techniques [e.g., transcranial magnetic stimulation (TMS), particularly its repetitive form (rTMS), transcranial alternating current stimulation (tACS), and transcranial direct current stimulation (tDCS)] in the context of musculoskeletal pain chronicity. We focus on the role of the motor cortex because of its known contribution to sensory components of pain via thalamic inhibition, and the role of the dorsolateral prefrontal cortex because of its role on cognitive and affective processing of pain. We will also discuss findings from studies using experimentally induced prolonged pain and studies implicating the DLPFC, which may shed light on the earliest transition phase to chronicity. We propose that combined brain stimulation and imaging studies might further advance mechanistic models of the chronicity process and involved brain circuits. Implications and challenges for translating the research on mechanistic models of the development of chronic pain to clinical practice will also be addressed.
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Affiliation(s)
- Mina Kandić
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Vera Moliadze
- Institute of Medical Psychology and Medical Sociology, University Hospital Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Jamila Andoh
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Herta Flor
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frauke Nees
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Institute of Medical Psychology and Medical Sociology, University Hospital Schleswig-Holstein, Kiel University, Kiel, Germany
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27
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Miyashiro S, Yamada Y, Nagaoka M, Shima R, Muta T, Ishikawa H, Abe T, Hori M, Oka K, Koshikawa F, Ito E. Pain relief associated with decreased oxyhemoglobin level in left dorsolateral prefrontal cortex. PLoS One 2021; 16:e0256626. [PMID: 34424921 PMCID: PMC8382195 DOI: 10.1371/journal.pone.0256626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 08/09/2021] [Indexed: 01/10/2023] Open
Abstract
Pain in the elbow, shoulder, knee, lower back, and various other joints is relieved by adhesion of pyramidal thorn patches. To elucidate the pain relief mechanism induced by the patches, we established a quantitative method for estimating the pain reduction and investigated the brain regions that change in association with pain relief. We first attempted to quantify the pain relief using transcutaneous electric stimulation (TCES) and a visual analog scale (VAS), and then applied near-infrared spectroscopy (NIRS) to the prefrontal cortex, including the dorsolateral prefrontal cortex (DLPFC) and the orbitofrontal cortex (OFC). We also examined the salivary oxytocin levels, which are thought to reflect oxytocin secretion levels from the posterior pituitary in the brain. Application of pyramidal thorn patches to pain regions decreased the pain degree estimated using TCES and VAS. Oxyhemoglobin levels were likely to be decreased in the left DLPFC on the basis of NIRS measurements during patch treatment, suggesting that the left DLPFC is involved in pain relief. On the other hand, the salivary oxytocin levels varied widely. A potential reason for the varying salivary oxytocin levels is its utilization in the pain region as an analgesic agent. Our results suggest that the left DLPFC will become a target brain region for pain therapy.
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Affiliation(s)
| | - Yurika Yamada
- Department of Biology, Waseda University, Tokyo, Japan
| | | | - Rei Shima
- Department of Biology, Waseda University, Tokyo, Japan
| | - Toshizumi Muta
- Department of Psychology, Waseda University, Tokyo, Japan
| | - Haruyuki Ishikawa
- Department of Culture, Media and Society, Waseda University, Tokyo, Japan
| | - Tetsuri Abe
- Department of Psychology, Waseda University, Tokyo, Japan
| | - Masashi Hori
- Department of Educational Psychology, Waseda University, Tokyo, Japan
| | - Kotaro Oka
- Department of Bioscience and Informatics, Keio University, Yokohama, Japan
- Waseda Research Institute for Science and Engineering, Waseda University, Tokyo, Japan
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Etsuro Ito
- Department of Biology, Waseda University, Tokyo, Japan
- Waseda Research Institute for Science and Engineering, Waseda University, Tokyo, Japan
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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tDCS randomized controlled trials in no-structural diseases: a quantitative review. Sci Rep 2021; 11:16311. [PMID: 34381076 PMCID: PMC8357949 DOI: 10.1038/s41598-021-95084-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/21/2021] [Indexed: 11/26/2022] Open
Abstract
The increasing number and quality of randomized controlled trials (RCTs) employing transcranial direct current stimulation (tDCS) denote the rising awareness of neuroscientific community about its electroceutical potential and opening to include these treatments in the framework of medical therapies under the indications of the international authorities. The purpose of this quantitative review is to estimate the recommendation strength applying the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria and PICO (population, intervention, comparison, outcome) model values for effective tDCS treatments on no-structural diseases, and to provide an estimate of Sham effect for future RCTs. Applying GRADE evaluation pathway, we searched in literature the tDCS-based RCTs in psychophysical diseases displaying a major involvement of brain electrical activity imbalances. Three independent authors agreed on Class 1 RCTs (18 studies) and meta-analyses were carried out using a random-effects model for pathologies sub-selected based on PICO and systemic involvement criteria. The meta-analysis integrated with extensive evidence of negligible side effects and low-cost, easy-to-use procedures, indicated that tDCS treatments for depression and fatigue in Multiple Sclerosis ranked between moderately and highly recommendable. For these interventions we reported the PICO variables, with left vs. right dorsolateral prefrontal target for 30 min/10 days against depression and bilateral somatosensory vs occipital target for 15 min/5 days against MS fatigue. An across-diseases meta-analysis devoted to the Sham effect provided references for power analysis in future tDCS RCTs on these clinical conditions. High-quality indications support tDCS as a promising tool to build electroceutical treatments against diseases involving neurodynamics alterations.
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The mapping of cortical activation by near-infrared spectroscopy might be a biomarker related to the severity of fibromyalgia symptoms. Sci Rep 2021; 11:15754. [PMID: 34344913 PMCID: PMC8333354 DOI: 10.1038/s41598-021-94456-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 07/05/2021] [Indexed: 01/01/2023] Open
Abstract
The delta value of oxyhemoglobin (Δ-HbO) determined by functional near-infrared spectroscopy at prefrontal cortex (PFC) and motor cortex (MC) based on primary (25 °C) and secondary (5 °C) thermal stimuli presented a larger peak latency at left MC in fibromyalgia than in controls. The difference between HbO concentration 15 s after the thermal stimuli ending and HbO concentration before the thermal stimuli onset (Δ-HbO*) at left PFC increased 47.82% in fibromyalgia and 76.66% in controls. This value had satisfactory discriminatory properties to differentiate cortical activation in fibromyalgia versus controls. A receiver operator characteristics (ROC) analysis showed the Δ-HbO* cutoffs of − 0.175 at left PFC and − 0.205 at right PFC offer sensitivity and specificity of at least 80% in screening fibromyalgia from controls. In fibromyalgia, a ROC analysis showed that these cutoffs could discriminate those with higher disability due to pain and more severe central sensitization symptoms (CSS). The ROC with the best discriminatory profile was the CSS score with the Δ-HbO* at left PFC (area under the curve = 0.82, 95% confidence interval = 0.61–100). These results indicate that cortical activation based on Δ-HbO* at left PFC might be a sensitive marker to identify fibromyalgia subjects with more severe clinical symptoms.
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Li X, Yao J, Zhang W, Chen S, Peng W. Effects of transcranial direct current stimulation on experimental pain perception: A systematic review and meta-analysis. Clin Neurophysiol 2021; 132:2163-2175. [PMID: 34284252 DOI: 10.1016/j.clinph.2021.05.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/01/2021] [Accepted: 05/16/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Many studies have examined the effectiveness of transcranial direct current stimulation (tDCS) on human pain perception in both healthy populations and pain patients. Nevertheless, studies have yielded conflicting results, likely due to differences in stimulation parameters, experimental paradigms, and outcome measures. Human experimental pain models that utilize indices of pain in response to well-controlled noxious stimuli can avoid many confounds present in clinical data. This study aimed to assess the robustness of tDCS effects on experimental pain perception among healthy populations. METHODS We conducted three meta-analyses that analyzed tDCS effects on ratings of perceived pain intensity to suprathreshold noxious stimuli, pain threshold and tolerance. RESULTS The meta-analyses showed a statically significant tDCS effect on attenuating pain-intensity ratings to suprathreshold noxious stimuli. In contrast, tDCS effects on pain threshold and pain tolerance were statistically non-significant. Moderator analysis further suggested that stimulation parameters (active electrode size and current density) and experimental pain modality moderated the effectiveness of tDCS in attenuating pain-intensity ratings. CONCLUSION The effectiveness of tDCS on attenuating experimental pain perception depends on both stimulation parameters of tDCS and the modality of experimental pain. SIGNIFICANCE This study provides some theoretical basis for the application of tDCS in pain management.
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Affiliation(s)
- Xiaoyun Li
- School of Psychology, Shenzhen University, Shenzhen, China
| | - Junjie Yao
- School of Psychology, Shenzhen University, Shenzhen, China
| | - Wenyun Zhang
- School of Psychology, Shenzhen University, Shenzhen, China
| | - Shengxiong Chen
- Medical Rehabilitation Center, Shenzhen Prevention and Treatment Center for Occupational Diseases, Shenzhen, China
| | - Weiwei Peng
- School of Psychology, Shenzhen University, Shenzhen, China; Shenzhen Key Laboratory of Affective and Social Cognitive Science, Shenzhen University, Shenzhen, China.
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31
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Lema A, Carvalho S, Fregni F, Gonçalves ÓF, Leite J. The effects of direct current stimulation and random noise stimulation on attention networks. Sci Rep 2021; 11:6201. [PMID: 33737661 PMCID: PMC7973424 DOI: 10.1038/s41598-021-85749-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/25/2021] [Indexed: 01/31/2023] Open
Abstract
Attention is a complex cognitive process that selects specific stimuli for further processing. Previous research suggested the existence of three attentional networks: alerting, orienting and executive. However, one important topic is how to enhance the efficiency of attentional networks. In this context, understanding how this system behaves under two different modulatory conditions, namely transcranial direct current stimulation (tDCS) and transcranial Random Noise Stimulation (tRNS), will provide important insights towards the understanding of the attention network system. Twenty-seven healthy students took part on a randomized single-blinded crossover study, testing the effects that involved three modalities of unilateral stimulation (tRNS, anodal tDCS, and sham) over the DLPFC, during the performance of the attention network test (ANT) in three different conditions: standard, speed and accuracy. Results showed that tRNS was able to increase attention during more complex situations, namely by increasing alerting and decreasing conflict effect in the executive network. Under the Speed condition, tRNS increased efficiency of the alerting network, as well as under the more demanding conflict network, tRNS overall increased the performance when comparing to sham. No statistical significant effects of tDCS were observed. These results are compatible with the attention requiring the synchronization of pre-existing networks, rather the reinforcement or creation of new pathways.
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Affiliation(s)
- Alberto Lema
- Psychological Neuroscience Laboratory, CIPsi, School of Psychology, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal
| | - Sandra Carvalho
- Psychological Neuroscience Laboratory, CIPsi, School of Psychology, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal
- Department of Education and Psychology, University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal
| | - Felipe Fregni
- Spaulding Neuromodulation Center, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital & Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Óscar F Gonçalves
- Proaction Laboratory, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Jorge Leite
- I2P-Portucalense Institute for Psychology, Portucalense University, Porto, Portugal.
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Gardoki-Souto I, Martín de la Torre O, Hogg B, Redolar-Ripoll D, Valiente-Gómez A, Martínez Sadurní L, Blanch JM, Lupo W, Pérez V, Radua J, Amann BL, Moreno-Alcázar A. Augmentation of EMDR with multifocal transcranial current stimulation (MtCS) in the treatment of fibromyalgia: study protocol of a double-blind randomized controlled exploratory and pragmatic trial. Trials 2021; 22:104. [PMID: 33514408 PMCID: PMC7844777 DOI: 10.1186/s13063-021-05042-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 01/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fibromyalgia (FM) is a generalized, widespread chronic pain disorder affecting 2.7% of the general population. In recent years, different studies have observed a strong association between FM and psychological trauma. Therefore, a trauma-focused psychotherapy, such as eye movement desensitization and reprocessing (EMDR), combined with a non-invasive brain stimulation technique, such as multifocal transcranial current stimulation (MtCS), could be an innovative adjunctive treatment option. This double-blind randomized controlled trial (RCT) analyzes if EMDR therapy is effective in the reduction of pain symptoms in FM patients and if its potential is boosted with the addition of MtCS. METHODS Forty-five patients with FM and a history of traumatic events will be randomly allocated to Waiting List, EMDR + active-MtCS, or EMDR + sham-MtCS. Therapists and patients will be kept blind to MtCS conditions, and raters will be kept blind to both EMDR and MtCS. All patients will be evaluated at baseline, post-treatment, and follow-up at 6 months after post-treatment. Evaluations will assess the following variables: sociodemographic data, pain, psychological trauma, sleep disturbance, anxiety and affective symptoms, and wellbeing. DISCUSSION This study will provide evidence of whether EMDR therapy is effective in reducing pain symptoms in FM patients, and whether the effect of EMDR can be enhanced by MtCS. TRIAL REGISTRATION ClinicalTrials.gov NCT04084795 . Registered on 2 August 2019.
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Affiliation(s)
- I. Gardoki-Souto
- Centre Forum Research Unit, Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, C/ Llull 410, 08019 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | | | - B. Hogg
- Centre Forum Research Unit, Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, C/ Llull 410, 08019 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - D. Redolar-Ripoll
- Cognitive NeuroLab, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - A. Valiente-Gómez
- Centre Forum Research Unit, Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, C/ Llull 410, 08019 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain
| | - L. Martínez Sadurní
- Institut de Neuropsiquiatria i Addiccions (INAD), Parc de Salut Mar, Barcelona, Spain
| | - J. M. Blanch
- Service of Rheumatology, Parc de Salut Mar, Barcelona, Spain
| | - W. Lupo
- Centre Forum Research Unit, Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, C/ Llull 410, 08019 Barcelona, Spain
| | - V. Pérez
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain
| | - J. Radua
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Karolinska Institutet, Solna, Sweden
- King’s College, London, England
| | - B. L. Amann
- Centre Forum Research Unit, Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, C/ Llull 410, 08019 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain
| | - A. Moreno-Alcázar
- Centre Forum Research Unit, Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, C/ Llull 410, 08019 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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郭 娅, 李 启, 姜 劲, 曹 勇, 冯 静, 楚 洪, 王 宏, 焦 学. [Review of cognitive enhancement techniques based on the combination of cognitive training and transcranial direct current stimulation]. SHENG WU YI XUE GONG CHENG XUE ZA ZHI = JOURNAL OF BIOMEDICAL ENGINEERING = SHENGWU YIXUE GONGCHENGXUE ZAZHI 2020; 37:903-909. [PMID: 33140616 PMCID: PMC10320545 DOI: 10.7507/1001-5515.201911079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Indexed: 11/03/2022]
Abstract
Cognitive enhancement refers to the technology of enhancing or expanding the cognitive and emotional abilities of people without psychosis based on relevant knowledge of neurobiology. The common methods of cognitive enhancement include transcranial direct current stimulation (tDCS) and cognitive training (CT). tDCS takes effect quickly, with a short effective time, while CT takes longer to work, requiring several weeks of training, with a longer effective time. In recent years, some researchers have begun to use the method of tDCS combined with CT to regulate the cognitive function. This paper will sort out and summarize this topic from five aspects: perception, attention, working memory, decision-making and other cognitive abilities. Finally, the application prospect and challenges of technology are prospected.
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Affiliation(s)
- 娅美 郭
- 航天工程大学 研究生院(北京 101416)Department of Graduate School, Space Engineering University, Beijing 101416, P.R.China
- 中国航天员科研训练中心 人因工程国防科技重点实验室(北京 100094)Key Laboratory of Human Factors Engineering, China Astronaut Research and Training Centre, Beijing 100094, P.R.China
| | - 启杰 李
- 航天工程大学 研究生院(北京 101416)Department of Graduate School, Space Engineering University, Beijing 101416, P.R.China
| | - 劲 姜
- 航天工程大学 研究生院(北京 101416)Department of Graduate School, Space Engineering University, Beijing 101416, P.R.China
| | - 勇 曹
- 航天工程大学 研究生院(北京 101416)Department of Graduate School, Space Engineering University, Beijing 101416, P.R.China
| | - 静达 冯
- 航天工程大学 研究生院(北京 101416)Department of Graduate School, Space Engineering University, Beijing 101416, P.R.China
| | - 洪祚 楚
- 航天工程大学 研究生院(北京 101416)Department of Graduate School, Space Engineering University, Beijing 101416, P.R.China
| | - 宏伟 王
- 航天工程大学 研究生院(北京 101416)Department of Graduate School, Space Engineering University, Beijing 101416, P.R.China
| | - 学军 焦
- 航天工程大学 研究生院(北京 101416)Department of Graduate School, Space Engineering University, Beijing 101416, P.R.China
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Beltran Serrano G, Pooch Rodrigues L, Schein B, Zortea M, Torres ILS, Fregni F, Caumo W. The Hypnotic Analgesia Suggestion Mitigated the Effect of the Transcranial Direct Current Stimulation on the Descending Pain Modulatory System: A Proof of Concept Study. J Pain Res 2020; 13:2297-2311. [PMID: 32982393 PMCID: PMC7502396 DOI: 10.2147/jpr.s253747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/24/2020] [Indexed: 12/20/2022] Open
Abstract
Objective We evaluated whether active(a)-tDCS combined with hypnotic analgesia suggestion (HS) would be more effective than a single active(a)-tDCS, and/or sham-(s)-tDCS and s-tDCS/HS on the following outcomes: function of descending pain modulatory system (DPMS) during the conditioned pain modulation test (CPM-test) (primary outcome), heat pain threshold (HPT), heat pain tolerance (HPTo) and cold pressor test (CPT) (secondary outcomes). We also examined whether their effects are related to neuroplasticity state evaluated by serum brain-derived-neurotropic factor (BDNF). Materials and Methods Forty-eight females received one session of one of the four interventions (a-tDCS/HS, s-tDCS/HS, a-tDCS, and s-tDCS) in an incomplete randomized crossover sequence. The a-tDCS or s-tDCS was applied over the left dorsolateral prefrontal cortex (DLPFC) for 30 minutes at 2mA. Results A generalized linear model revealed a significant main effect for the intervention group (P <0.032). The delta-(Δ) pain score on the Numerical Pain Scale (NPS0-10) during CPM-test in the a-tDCS/HS group was -0.25 (0.43). The (Δ) pain score on NPS (0-10) during CPM-test in the other three groups was a-tDCS=-0.54 (0.41), HS -0.01 (0.41) and s-tDCS/HS=-0.19 (0.43). A-tDCS/HS intervention increased the CPT substantially compared to all other interventions. Also, higher baseline levels of BDNF were associated with a larger change in CPT and HPTo. Conclusion These findings indicate that the HS combined with a-tDCS mitigated the effect of the a-tDCS on the DPMS. The a-tDCS up-regulates the inhibition on DPMS, and the HS improved pain tolerance. And, together they enhanced the reaction time substantially upon the CPT. Clinical Trial Registration www.ClinicalTrials.gov, identifier NCT03744897.
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Affiliation(s)
- Gerardo Beltran Serrano
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil.,Laboratory of Pain and Neuromodulation at Hospital De Clínicas De Porto Alegre (HCPA), Porto Alegre, Brazil.,Psychology Department, Universidad Catolica De Cuenca, UCACUE, Cuenca, Ecuador
| | - Laura Pooch Rodrigues
- Laboratory of Pain and Neuromodulation at Hospital De Clínicas De Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Bruno Schein
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil.,Laboratory of Pain and Neuromodulation at Hospital De Clínicas De Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Maxciel Zortea
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil.,Laboratory of Pain and Neuromodulation at Hospital De Clínicas De Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Iraci Lucenada Silva Torres
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil.,Department of Pharmacology, Institute of Health Sciences (ICBS), Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil.,Pharmacology of Pain and Neuromodulation: Pre-Clinical Investigations Research Group, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
| | - Felipe Fregni
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Wolnei Caumo
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil.,Laboratory of Pain and Neuromodulation at Hospital De Clínicas De Porto Alegre (HCPA), Porto Alegre, Brazil.,Pharmacology of Pain and Neuromodulation: Pre-Clinical Investigations Research Group, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
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35
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Coussement C, de Vega MR, Heeren A. The Impact of Anodal tDCS on the Attentional Networks as a Function of Trait Anxiety and Depressive Symptoms: A Preregistered Double-Blind Sham-Controlled Experiment. CLINICAL NEUROPSYCHIATRY 2020; 17:225-235. [PMID: 34908998 PMCID: PMC8629077 DOI: 10.36131/cnfioritieditore20200404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Attention is a multifaceted construct, including three distinct attentional networks: the alerting, orienting, and executive conflict networks. Recently, researchers have started to envision strategies to enhance the attentional networks, and transcranial Direct Current Stimulation (tDCS) has emerged as a promising tool to do so, especially regarding the executive conflict network. On the other hand, other research lines have suggested that anodal tDCS might yield more substantial impacts among depressive and anxious participants. METHOD In this preregistered study, we thus examined two questions. First, we wanted to replicate previous observations and tested whether anodal tDCS does improve the executive conflict network's efficiency. Second, we set out to clarify the impact of anxiety and depressive symptoms on this effect. To do so, we adopted a double-blind within-subject protocol in an unselected sample (n = 50) and delivered a single session of anodal- applied over the dorsolateral part of the left prefrontal cortex-versus sham tDCS during the completion of a task assessing the attentional networks. We assessed anxiety and depressive symptoms at baseline. RESULTS AND CONCLUSIONS Although there were no significant direct effects of tDCS on the attentional networks, we found that the higher the levels of depression and trait anxiety, the larger the executive conflict network's enhancement during tDCS. By highlighting the importance of trait anxiety and depression when considering the impact of tDCS on the attentional networks, this study fulfills a valuable niche in clinical neuroscience, wherein preclinical data provide critical clues for larger, more definitive future translational efforts.
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Affiliation(s)
- Charlotte Coussement
- Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium,Department of Clinical Research and Scientific Publications, Le Beau Vallon – Psychiatric Hospital, Namur, Belgium
| | | | - Alexandre Heeren
- Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium,Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium,Corresponding author Alexandre Heeren, Psychological Sciences Research Institute, Université catholique de Louvain, 10 Place du Cardinal Mercier, 1348 Louvain-la-Neuve, Belgium. E-mail:
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Coskun Benlidayi I. The effectiveness and safety of electrotherapy in the management of fibromyalgia. Rheumatol Int 2020; 40:1571-1580. [PMID: 32524302 DOI: 10.1007/s00296-020-04618-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/31/2020] [Indexed: 12/31/2022]
Abstract
Treating fibromyalgia is a challenging task for physicians. With its multifaceted features, fibromyalgia requires a comprehensive management strategy focusing on both the pharmacological and non-pharmacological treatment options. During the last decades, there has been growing evidence regarding the role of electrotherapy in fibromyalgia treatment. In this regard, the present article aimed to review the recent literature on the effectiveness and safety of the electrotherapy in the treatment of fibromyalgia. A literature search was conducted through PubMed/MEDLINE and Scopus databases. Transcutaneous electrical nerve stimulation (TENS), non-invasive brain stimulation (transcranial direct current/magnetic stimulation), and light amplification by stimulated emission of radiation (LASER) emerged as the most commonly examined electrotherapy techniques in fibromyalgia. Currently, there is growing data regarding the effectiveness of electrotherapy in the management of fibromyalgia-related pain. Besides, non-invasive electrotherapy techniques are related to no/minor side effects. Further studies are warranted to identify the optimal treatment protocols for each electrotherapy modality.
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Affiliation(s)
- Ilke Coskun Benlidayi
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Cukurova University, Adana, Turkey.
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Meeker TJ, Jupudi R, Lenz FA, Greenspan JD. New Developments in Non-invasive Brain Stimulation in Chronic Pain. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020; 8:280-292. [PMID: 33473332 DOI: 10.1007/s40141-020-00260-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose of Review The goal of this review is to present a summary of the recent literature of a non-invasive brain stimulation (NIBS) to alleviate pain in people with chronic pain syndromes. This article reviews the current evidence for the use of transcranial direct current (tDCS) and repetitive transcranial magnetic stimulation (rTMS) to improve outcomes in chronic pain. Finally, we introduce the reader to novel stimulation methods that may improve therapeutic outcomes in chronic pain. Recent Findings While tDCS is approved for treatment of fibromyalgia in Canada and the European Union, no NIBS method is currently approved for chronic pain in the United States. Increasing sample sizes in randomized clinical trials (RCTs) seems the most efficient way to increase confidence in initial promising results. Trends at funding agencies reveal increased interest and support for NIBS such as recent Requests for Application from the National Institutes of Health. NIBS in conjunction with cognitive behavioral therapy and physical therapy may enhance outcomes in chronic pain. Novel stimulation methods, such as transcranial ultrasound stimulation, await rigorous study in chronic pain.
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Affiliation(s)
- Timothy J Meeker
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Dept. of Neural and Pain Sciences, School of Dentistry, and Center to Advance Chronic Pain Research, Univ. of Maryland Baltimore, Baltimore, MD, USA
| | - Rithvic Jupudi
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - Frederik A Lenz
- Dept. of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - Joel D Greenspan
- Dept. of Neural and Pain Sciences, School of Dentistry, and Center to Advance Chronic Pain Research, Univ. of Maryland Baltimore, Baltimore, MD, USA
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Angius L, Santarnecchi E, Pascual-Leone A, Marcora SM. Transcranial Direct Current Stimulation over the Left Dorsolateral Prefrontal Cortex Improves Inhibitory Control and Endurance Performance in Healthy Individuals. Neuroscience 2019; 419:34-45. [PMID: 31493549 DOI: 10.1016/j.neuroscience.2019.08.052] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 01/25/2023]
Abstract
The dorsolateral prefrontal cortex (DLPFC) is a crucial brain region for inhibitory control, an executive function essential for behavioral self-regulation. Recently, inhibitory control has been shown to be important for endurance performance. Improvement in inhibitory control was found following transcranial direct current stimulation (tDCS) applied over the left DLPFC (L-DLPFC). This study examined the effect tDCS on both an inhibitory control and endurance performance in a group of healthy individuals. Twelve participants received either real tDCS (Real-tDCS) or placebo tDCS (Sham-tDCS) in randomized order. The anodal electrode was placed over the L-DLPFC while the cathodal electrode was placed above Fp2. Stimulation lasted 30min with current intensity set at 2mA. A Stroop test was administered to assess inhibitory control. Heart rate (HR), ratings of perceived exertion (RPE), and leg muscle pain (PAIN) were monitored during the cycling time to exhaustion (TTE) test, while blood lactate accumulation (∆B[La-]) was measured at exhaustion. Stroop task performance was improved after Real-tDCS as demonstrated by a lower number of errors for incongruent stimuli (p=0.012). TTE was significantly longer following Real-tDCS compared to Sham-tDCS (p=0.029, 17±8 vs 15±8min), with significantly lower HR (p=0.002) and RPE (p<0.001), while no significant difference was found for PAIN (p>0.224). ∆B[La-] was significantly higher at exhaustion in Real-tDCS (p=0.040). Our findings provide preliminary evidence that tDCS with the anodal electrode over the L-DLPFC can improve both inhibitory control and endurance cycling performance in healthy individuals.
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Affiliation(s)
- L Angius
- Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Chatham Maritime, United Kingdom; Faculty of Health and Life Sciences, Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, United Kingdom.
| | - E Santarnecchi
- Berenson-Allen Center for Non-Invasive Brain Stimulation, Division of Cognitive Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - A Pascual-Leone
- Berenson-Allen Center for Non-Invasive Brain Stimulation, Division of Cognitive Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Institut Universitari de Neurorehabilitacio Guttmann, Badalona, Barcelona, Spain
| | - S M Marcora
- Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Chatham Maritime, United Kingdom; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
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Brietzke AP, Zortea M, Carvalho F, Sanches PRS, Silva DPJ, Torres ILDS, Fregni F, Caumo W. Large Treatment Effect With Extended Home-Based Transcranial Direct Current Stimulation Over Dorsolateral Prefrontal Cortex in Fibromyalgia: A Proof of Concept Sham-Randomized Clinical Study. THE JOURNAL OF PAIN 2019; 21:212-224. [PMID: 31356985 DOI: 10.1016/j.jpain.2019.06.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/23/2019] [Accepted: 06/27/2019] [Indexed: 10/26/2022]
Abstract
This randomized, double-blind controlled trial tested the hypothesis that 60 sessions of home-based anodal (a)-transcranial direct current stimulation (tDCS) over dorsolateral prefrontal cortex (DLPFC) would be better than home-based sham-tDCS to improve the widespread pain and the disability-related to pain. The anodal-tDCS (2 mA for 30 minutes) over the left DLPFC was self-administered with a specially developed device following in-person training. Twenty women, 18 to 65 years old were randomized into 2 groups [active-(a)-tDCS (n = 10) or sham-(s)-tDCS (n = 10)]. Post hoc analysis revealed that after the first 20 sessions of a-tDCS, the cumulative pain scores reduced by 45.65% [7.25 (1.43) vs 3.94 (1.14), active vs sham tDCS, respectively]. After 60 sessions, during the 12-week assessment, pain scores reduced by 62.06% in the actively group [visual analogue scale reduction, 7.25 (1.43) to 2.75 (.85)] compared to 24.92% in the s-tDCS group, [mean (SD) 7.10 (1.81) vs 5.33 (.90)], respectively. It reduced the risk for analgesic use in 55%. Higher serum levels of the brain-derived neurotrophic factor predicted higher decreases on the pain scores across of treatment. PERSPECTIVE: These findings bring 3 important insights: 1) show that an extended period of treatment (60 sessions, to date the largest number of tDCS sessions tested) for fibromyalgia induces large pain decreases (a large effect size of 1.59) and 2) support the feasibility of home-based tDCS as a method of intervention; 3) provide additional data on DLPFC target for the treatment of fibromyalgia. Finally, our findings also highlight that brain-derived neurotrophic factor to index neuroplasticity may be a valuable predictor of the tDCS effect on pain scores decreases across the treatment.
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Affiliation(s)
- Aline P Brietzke
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Maxciel Zortea
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Fabiana Carvalho
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | | | | | - Iraci Lucena da Silva Torres
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Laboratory of Biomedical Engineering at HCPA, Porto Alegre, Brazil; Laboratory of Neuromodulation and Center for Clinical Research Learning, Physics and Rehabilitation Department, Spaulding Rehabilitation Hospital, Boston, Massachusetts; Pain and Palliative Care Service at HCPA, Porto Alegre, Brazil; Department of Surgery, School of Medicine, UFRGS, Porto Alegre, Brazil
| | - Felipe Fregni
- Laboratory of Neuromodulation and Center for Clinical Research Learning, Physics and Rehabilitation Department, Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Wolnei Caumo
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Laboratory of Neuromodulation and Center for Clinical Research Learning, Physics and Rehabilitation Department, Spaulding Rehabilitation Hospital, Boston, Massachusetts; Pain and Palliative Care Service at HCPA, Porto Alegre, Brazil; Department of Surgery, School of Medicine, UFRGS, Porto Alegre, Brazil.
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40
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Beltran Serrano G, Rodrigues LP, Schein B, Souza A, Torres ILS, da Conceição Antunes L, Fregni F, Caumo W. Comparison of Hypnotic Suggestion and Transcranial Direct-Current Stimulation Effects on Pain Perception and the Descending Pain Modulating System: A Crossover Randomized Clinical Trial. Front Neurosci 2019; 13:662. [PMID: 31297046 PMCID: PMC6608544 DOI: 10.3389/fnins.2019.00662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/07/2019] [Indexed: 01/09/2023] Open
Abstract
Objectives: This paper aims to determine if hypnotic analgesia suggestion and transcranial direct-current stimulation (tDCS) have a differential effect on pain perception. We hypothesized that transcranial direct-current stimulation would be more effective than hypnotic analgesia suggestion at changing the descending pain modulating system, whereas the hypnotic suggestion would have a greater effect in quantitative sensory testing. Design: This is a randomized, double blind and crossover trial. Settings: All stages of this clinical trial were performed at the Laboratory of Pain and Neuromodulation of the Hospital de Clínicas de Porto Alegre. Subjects: Were included 24 healthy females aged from 18 to 45 years old, with a high susceptibility to hypnosis, according to the Waterloo-Stanford Group Scale of Hypnotic Susceptibility, Form C (15). Methods: The subjects received a random and crossover transcranial direct-current stimulation over the dorsolateral prefrontal cortex (2 mA for 20 min) and hypnotic analgesia (20 min). Results: Only hypnotic suggestion produced changes that are statistically significant from pre- to post-intervention in the following outcomes measures: heat pain threshold, heat pain tolerance, cold pressure test, and serum brain-derivate-neurotrophic-factor. The analysis showed a significant main effect for treatment (F = 4.32; P = 0.04) when we compared the delta-(Δ) of conditioned pain modulation task between the transcranial direct-current stimulation and hypnotic suggestion groups. Also, the change in the brain-derivate-neurotrophic-factor was positively correlated with the conditioned pain modulation task. Conclusion: The results confirm a differential effect between hypnotic suggestion and transcranial direct-current stimulation on the pain measures. They suggest that the impact of the interventions has differential neural mechanisms, since the hypnotic suggestion improved pain perception, whereas the transcranial direct-current stimulation increased inhibition of the descending pain modulating system. Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT03744897. Perspective: These findings highlight the effect of hypnotic suggestion on contra-regulating mechanisms involved in pain perception, while the transcranial direct-current stimulation increased inhibition of the descending pain modulating system. They could help clinicians comprehend the mechanisms involved in hypnotic analgesia and transcranial direct-current stimulation and thus may contribute to pain and disability management.
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Affiliation(s)
- Gerardo Beltran Serrano
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Pain and Palliative Care Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Psychology Department, Universidad Católica de Cuenca, Cuenca, Ecuador
| | - Laura Pooch Rodrigues
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Bruno Schein
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Andressa Souza
- Department of Nutrition, Health Science Center, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
| | - Iraci L S Torres
- Postgraduate Program in Health and Human Development, La Salle University, Canoas, Brazil
| | - Luciana da Conceição Antunes
- Department of Nutrition, Health Science Center, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
| | - Felipe Fregni
- Berenson-Allen Center for Noninvasive Brain Stimulation, Harvard Medical School, Boston, MA, United States.,Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Wolnei Caumo
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Pain and Palliative Care Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Pharmacology, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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41
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Brighina F, Curatolo M, Cosentino G, De Tommaso M, Battaglia G, Sarzi-Puttini PC, Guggino G, Fierro B. Brain Modulation by Electric Currents in Fibromyalgia: A Structured Review on Non-invasive Approach With Transcranial Electrical Stimulation. Front Hum Neurosci 2019; 13:40. [PMID: 30804771 PMCID: PMC6378756 DOI: 10.3389/fnhum.2019.00040] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 01/24/2019] [Indexed: 01/13/2023] Open
Abstract
Fibromyalgia syndrome (FMS) is a complex disorder where widespread musculoskeletal pain is associated with many heterogenous symptoms ranging from affective disturbances to cognitive dysfunction and central fatigue. FMS is currently underdiagnosed and often very poorly responsive to pharmacological treatment. Pathophysiology of the disease remains still obscure even if in the last years fine structural and functional cerebral abnormalities have been identified, principally by neurophysiological and imaging studies delineating disfunctions in pain perception, processing and control systems. On such basis, recently, neurostimulation of brain areas involved in mechanism of pain processing and control (primary motor cortex: M1 and dorsolateral prefrontal cortex: DLPFC) has been explored by means of different approaches and particularly through non-invasive brain stimulation techniques (transcranial magnetic and electric stimulation: TMS and tES). Here we summarize studies on tES application in FMS. The great majority of reports, based on direct currents (transcranial direct currents stimulation: tDCS) and targeting M1, showed efficacy on pain measures and less on cognitive and affective symptoms, even if several aspects as maintenance of therapeutical effects and optimal stimulation parameters remain to be established. Differently, stimulation of DLPFC, explored in a few studies, was ineffective on pain and showed limited effects on cognitive and affective symptoms. Very recently new tES techniques as high-density tDCS (HD-tDCS), transcranial random noise stimulation (tRNS) and tDCS devices for home-based treatment have been explored in FMS with interesting even if very preliminary results opening interesting perspectives for more effective, well tolerated, cheap and easy therapeutic approaches.
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Affiliation(s)
- Filippo Brighina
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata (BIND), Università degli Studi di Palermo, Palermo, Italy
| | - Massimiliano Curatolo
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata (BIND), Università degli Studi di Palermo, Palermo, Italy
| | - Giuseppe Cosentino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,IRCCS Mondino Foundation, Pavia, Italy
| | - Marina De Tommaso
- Unità di Neurofisiopatologia del Dolore, Dipartimento di Scienze Mediche di Base, Neuroscienze e Organi di Senso (SMBNOS), Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Giuseppe Battaglia
- Dipartimento di Scienze Psicologiche, Pedagogiche, dell'Esercizio Fisico e della Formazione, Università degli Studi di Palermo, Palermo, Italy
| | | | - Giuliana Guggino
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Università degli Studi di Palermo, Palermo, Italy
| | - Brigida Fierro
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata (BIND), Università degli Studi di Palermo, Palermo, Italy
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42
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Abstract
Fibromyalgia is a common disorder and has substantial impact on quality of life. The cause remains unknown, but current evidence points to multifactorial involvement of pain processing. Clinical diagnosis is aided by evidence-based diagnostic criteria with subscores for widespread pain and symptom severity. Nonpharmacologic treatments, including cognitive behavioral therapy, sleep hygiene, and regular aerobic exercise, form the cornerstone of management. Pharmacologic intervention is an important adjunct, but benefit is variable. There is no cure for fibromyalgia at this time, but persistence and patience in management may lead to a satisfactory lifestyle.
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Affiliation(s)
- Jay B Higgs
- Brooke Army Medical Center, MCHE-ZDM-MDR, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234-4504, USA.
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43
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Jiang N, Li G, Wei J, Wei B, Zhu FF, Hu Y. Transcranial direct current stimulation of the primary motor cortex on postoperative pain and spontaneous oscillatory electroencephalographic activity following lumbar spine surgery: A pilot study. Restor Neurol Neurosci 2018; 36:605-620. [DOI: 10.3233/rnn-180816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Naifu Jiang
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Guangsheng Li
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
- Spinal Division, Department of Orthopaedics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jinsong Wei
- Spinal Division, Department of Orthopaedics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Bo Wei
- Spinal Division, Department of Orthopaedics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Frank F. Zhu
- Faculty of Education, The University of Hong Kong, Hong Kong
| | - Yong Hu
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
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44
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Abstract
Transcranial direct current stimulation (tDCS) modulates spontaneous neuronal activity that can generate long-term neuroplastic changes. It has been used in numerous therapeutic trials showing significant clinical effects especially when combined with other behavioral therapies. One area of intensive tDCS research is chronic pain. Since the initial tDCS trials for chronic pain treatment using current parameters of stimulation, more than 60 clinical trials have been published testing its effects in different pain syndromes. However, as the field moves in the direction of clinical application, several aspects need to be taken into consideration regarding tDCS effectiveness and parameters of stimulation. In this article, we reviewed the evidence of tDCS effects for the treatment of chronic pain and critically analyzed the literature pertaining its safety and efficacy, and how to optimize tDCS clinical effects in a therapeutic setting. We discuss optimization of tDCS effects in 3 different domains: (i) parameters of stimulation, (ii) combination therapies, and (iii) subject selection. This article aims to provide insights for the development of future tDCS clinical trials.
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Affiliation(s)
- Camila Bonin Pinto
- Laboratory of Neuromodulation & Center for Clinical Research Learning, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Beatriz Teixeira Costa
- Laboratory of Neuromodulation & Center for Clinical Research Learning, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Dante Duarte
- Laboratory of Neuromodulation & Center for Clinical Research Learning, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Felipe Fregni
- Laboratory of Neuromodulation & Center for Clinical Research Learning, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
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45
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Cognitive effects of transcranial direct current stimulation combined with working memory training in fibromyalgia: a randomized clinical trial. Sci Rep 2018; 8:12477. [PMID: 30127510 PMCID: PMC6102237 DOI: 10.1038/s41598-018-30127-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/17/2018] [Indexed: 12/20/2022] Open
Abstract
Cognitive dysfunction in fibromyalgia has been reported, especially memory. Anodal transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) has been effective in enhancing this function. We tested the effects of eight sessions of tDCS and cognitive training on immediate and delayed memory, verbal fluency and working memory and its association with brain-derived neurotrophic factor (BDNF) levels. Forty females with fibromyalgia were randomized to receive eight sessions of active or sham tDCS. Anodal stimulation (2 mA) was applied over the DLPFC and online combined with a working memory training (WMT) for 20 minutes. Pre and post-treatment neurocognitive tests were administered. Data analysis on deltas considering years of education and BDNF as covariates, indicated active-tDCS + WMT significantly increased immediate memory indexed by Rey Auditory Verbal Learning Test score when compared to sham. This effect was dependent on basal BDNF levels. In addition, the model showed active stimulation increased orthographic and semantic verbal fluency scores (Controlled Oral Word Association Test) and short-term memory (Forward Digit Span). The combination of both techniques seemed to produce effects on specific cognitive functions related to short-term and long-term episodic memory and executive functions, which has clinical relevance for top-down treatment approaches in FM.
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46
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Hu X, Racek A, Bellile E, Nascimento T, Bender M, Toback R, Burnett D, Khatib L, McMahan R, Kovelman I, Ellwood R, DaSilva A. Brain Functional Changes before, during, and after Clinical Pain. J Dent Res 2018; 97:523-529. [PMID: 29324076 PMCID: PMC9096192 DOI: 10.1177/0022034517750136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
This study used an emerging brain imaging technique, functional near-infrared spectroscopy (fNIRS), to investigate functional brain activation and connectivity that modulates sometimes traumatic pain experience in a clinical setting. Hemodynamic responses were recorded at bilateral somatosensory (S1) and prefrontal cortices (PFCs) from 12 patients with dentin hypersensitivity in a dental chair before, during, and after clinical pain. Clinical dental pain was triggered with 20 consecutive descending cold stimulations (32° to 0°C) to the affected teeth. We used a partial least squares path modeling framework to link patients' clinical pain experience with recorded hemodynamic responses at sequential stages and baseline resting-state functional connectivity (RSFC). Hemodynamic responses at PFC/S1 were sequentially elicited by expectation, cold detection, and pain perception at a high-level coefficient (coefficients: 0.92, 0.98, and 0.99, P < 0.05). We found that the pain ratings were positively affected only at a moderate level of coefficients by such sequence of functional activation (coefficient: 0.52, P < 0.05) and the baseline PFC-S1 RSFC (coefficient: 0.59, P < 0.05). Furthermore, when the dental pain had finally subsided, the PFC increased its functional connection with the affected S1 orofacial region contralateral to the pain stimulus and, in contrast, decreased with the ipsilateral homuncular S1 regions ( P < 0.05). Our study indicated for the first time that patients' clinical pain experience in the dental chair can be predicted concomitantly by their baseline functional connectivity between S1 and PFC, as well as their sequence of ongoing hemodynamic responses. In addition, this linked cascade of events had immediate after-effects on the patients' brain connectivity, even when clinical pain had already ceased. Our findings offer a better understating of the ongoing impact of affective and sensory experience in the brain before, during, and after clinical dental pain.
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Affiliation(s)
- X. Hu
- Headache & Orofacial Pain
Effort, Biologic & Materials Sciences Department, University of Michigan
School of Dentistry, Ann Arbor, MI, USA
- Center for Human Growth and
Development, University of Michigan, Ann Arbor, MI, USA
| | - A.J. Racek
- Headache & Orofacial Pain
Effort, Biologic & Materials Sciences Department, University of Michigan
School of Dentistry, Ann Arbor, MI, USA
| | - E. Bellile
- Headache & Orofacial Pain
Effort, Biologic & Materials Sciences Department, University of Michigan
School of Dentistry, Ann Arbor, MI, USA
- Biostatistics Department,
University of Michigan, Ann Arbor, MI, USA
| | - T.D. Nascimento
- Headache & Orofacial Pain
Effort, Biologic & Materials Sciences Department, University of Michigan
School of Dentistry, Ann Arbor, MI, USA
| | - M.C. Bender
- Headache & Orofacial Pain
Effort, Biologic & Materials Sciences Department, University of Michigan
School of Dentistry, Ann Arbor, MI, USA
| | - R.L. Toback
- Headache & Orofacial Pain
Effort, Biologic & Materials Sciences Department, University of Michigan
School of Dentistry, Ann Arbor, MI, USA
| | - D. Burnett
- Headache & Orofacial Pain
Effort, Biologic & Materials Sciences Department, University of Michigan
School of Dentistry, Ann Arbor, MI, USA
| | - L. Khatib
- Headache & Orofacial Pain
Effort, Biologic & Materials Sciences Department, University of Michigan
School of Dentistry, Ann Arbor, MI, USA
| | - R. McMahan
- Headache & Orofacial Pain
Effort, Biologic & Materials Sciences Department, University of Michigan
School of Dentistry, Ann Arbor, MI, USA
| | - I. Kovelman
- Center for Human Growth and
Development, University of Michigan, Ann Arbor, MI, USA
- Department of Psychology,
University of Michigan, Ann Arbor, MI, USA
| | - R.P. Ellwood
- Clinical Method Development,
Colgate Palmolive, Piscataway, NJ, USA
| | - A.F. DaSilva
- Headache & Orofacial Pain
Effort, Biologic & Materials Sciences Department, University of Michigan
School of Dentistry, Ann Arbor, MI, USA
- Center for Human Growth and
Development, University of Michigan, Ann Arbor, MI, USA
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47
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Bi Y, Yuan K, Yu D, Wang R, Li M, Li Y, Zhai J, Lin W, Tian J. White matter integrity of central executive network correlates with enhanced brain reactivity to smoking cues. Hum Brain Mapp 2017; 38:6239-6249. [PMID: 28960762 DOI: 10.1002/hbm.23830] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 09/13/2017] [Accepted: 09/19/2017] [Indexed: 12/15/2022] Open
Abstract
The attentional bias to smoking cues contributes to smoking cue reactivity and cognitive declines underlines smoking behaviors, which were probably associated with the central executive network (CEN). However, little is known about the implication of the structural connectivity of the CEN in smoking cue reactivity and cognitive control impairments in smokers. In the present study, the white matter structural connectivity of the CEN was quantified in 35 smokers and 26 non-smokers using the diffusion tensor imaging and deterministic fiber tractography methods. Smoking cue reactivity was evaluated using cue exposure tasks, and cognitive control performance was assessed by the Stroop task. Relative to non-smokers, smokers showed increased fractional anisotropy (FA) values of the bilateral CEN fiber tracts. The FA values of left CEN positively correlated with the smoking cue-induced activation of the dorsolateral prefrontal cortex and right middle occipital cortex in smokers. Meanwhile, the FA values of left CEN positively correlated with the incongruent errors during Stroop task in smokers. Collectively, the present study highlighted the role of the structural connectivity of the CEN in smoking cue reactivity and cognitive control performance, which may underpin the attentional bias to smoking cues and cognitive deficits in smokers. The multimodal imaging method by forging links from brain structure to brain function extended the notion that structural connections can modulate the brain activity in specific projection target regions. Hum Brain Mapp 38:6239-6249, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Yanzhi Bi
- School of Life Science and Technology, Xidian University, Xi'an, People's Republic of China.,Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, People's Republic of China
| | - Kai Yuan
- School of Life Science and Technology, Xidian University, Xi'an, People's Republic of China.,Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, People's Republic of China.,School of Information Engineering, Information Processing Laboratory, Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, People's Republic of China
| | - Dahua Yu
- School of Information Engineering, Information Processing Laboratory, Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, People's Republic of China
| | - Ruonan Wang
- School of Life Science and Technology, Xidian University, Xi'an, People's Republic of China.,Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, People's Republic of China
| | - Min Li
- School of Life Science and Technology, Xidian University, Xi'an, People's Republic of China.,Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, People's Republic of China
| | - Yangding Li
- Guangxi Key Laboratory of Multi-Source Information Mining and Security, Guangxi Normal University, Guilin, People's Republic of China
| | - Jinquan Zhai
- Department of Medical Imaging, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, People's Republic of China
| | - Wei Lin
- Department of neurosurgery, No 101 Hospital of Chinese PLA, Wuxi, People's Republic of China
| | - Jie Tian
- School of Life Science and Technology, Xidian University, Xi'an, People's Republic of China.,Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, People's Republic of China.,Institute of Automation, Chinese Academy of Sciences, Beijing, People's Republic of China
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48
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Miler JA, Meron D, Baldwin DS, Garner M. The Effect of Prefrontal Transcranial Direct Current Stimulation on Attention Network Function in Healthy Volunteers. Neuromodulation 2017; 21:355-361. [DOI: 10.1111/ner.12629] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/04/2017] [Accepted: 05/20/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Joanna Astrid Miler
- Department of Psychology; Faculty of Social, Human and Mathematical Sciences, University of Southampton; Southampton UK
- Department of Psychiatry, Faculty of Medicine; University of Southampton; Southampton UK
| | - Daniel Meron
- Department of Psychiatry, Faculty of Medicine; University of Southampton; Southampton UK
- Clinical and Experimental Sciences; Faculty of Medicine, University of Southampton; Southampton UK
| | - David S. Baldwin
- Department of Psychiatry, Faculty of Medicine; University of Southampton; Southampton UK
- Clinical and Experimental Sciences; Faculty of Medicine, University of Southampton; Southampton UK
| | - Matthew Garner
- Department of Psychology; Faculty of Social, Human and Mathematical Sciences, University of Southampton; Southampton UK
- Department of Psychiatry, Faculty of Medicine; University of Southampton; Southampton UK
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49
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Transcranial direct current stimulation over the primary motor vs prefrontal cortex in refractory chronic migraine: A pilot randomized controlled trial. J Neurol Sci 2017; 378:225-232. [PMID: 28566169 DOI: 10.1016/j.jns.2017.05.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 04/04/2017] [Accepted: 05/02/2017] [Indexed: 12/21/2022]
Abstract
Although transcranial direct current stimulation (tDCS) represents a therapeutic option for the prophylaxis of chronic migraine, the target area for application of the electrical current to the cortex has not yet been well established. Here we sought to determine whether a treatment protocol involving 12 sessions of 2mA, 20min anodal stimulation of the left primary motor (M1) or dorsolateral prefrontal cortex (DLPFC) could offer clinical benefits in the management of pain from migraine. Thirteen participants were assessed before and after treatment, using the Headache Impact Test-6, Visual Analogue Scale and Medical Outcomes Study 36 - Item Short - Form Health Survey. After treatment, group DLPFC exhibited a better performance compared with groups M1 and sham. On intragroup comparison, groups DLPFC and M1 exhibited a greater reduction in headache impact and pain intensity and a higher quality of life after treatment. No significant change was found in group sham. The participants in group M1 exhibited more adverse effects, especially headache, heartburn, and sleepiness, than did those in the other two groups. Transcranial direct current stimulation is a safe and efficacious technique for treating chronic migraine. However, it should be kept in mind that the site of cortical stimulation might modulate the patient's response to treatment.
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