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Mujib MD, Rao AZ, Hasan MA, Ikhlaq A, Shahid H, Bano N, Mustafa MU, Mukhtar F, Nisa M, Qazi SA. Comparative Neurological and Behavioral Assessment of Central and Peripheral Stimulation Technologies for Induced Pain and Cognitive Tasks. Biomedicines 2024; 12:1269. [PMID: 38927476 PMCID: PMC11201146 DOI: 10.3390/biomedicines12061269] [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: 03/13/2024] [Revised: 04/22/2024] [Accepted: 05/03/2024] [Indexed: 06/28/2024] Open
Abstract
Pain is a multifaceted, multisystem disorder that adversely affects neuro-psychological processes. This study compares the effectiveness of central stimulation (transcranial direct current stimulation-tDCS over F3/F4) and peripheral stimulation (transcutaneous electrical nerve stimulation-TENS over the median nerve) in pain inhibition during a cognitive task in healthy volunteers and to observe potential neuro-cognitive improvements. Eighty healthy participants underwent a comprehensive experimental protocol, including cognitive assessments, the Cold Pressor Test (CPT) for pain induction, and tDCS/TENS administration. EEG recordings were conducted pre- and post-intervention across all conditions. The protocol for this study was categorized into four groups: G1 (control), G2 (TENS), G3 (anodal-tDCS), and G4 (cathodal-tDCS). Paired t-tests (p < 0.05) were conducted to compare Pre-Stage, Post-Stage, and neuromodulation conditions, with t-values providing insights into effect magnitudes. The result showed a reduction in pain intensity with TENS (p = 0.002, t-value = -5.34) and cathodal-tDCS (p = 0.023, t-value = -5.08) and increased pain tolerance with TENS (p = 0.009, t-value = 4.98) and cathodal-tDCS (p = 0.001, t-value = 5.78). Anodal-tDCS (p = 0.041, t-value = 4.86) improved cognitive performance. The EEG analysis revealed distinct neural oscillatory patterns across the groups. Specifically, G2 and G4 showed delta-power reductions, while G3 observed an increase. Moreover, G2 exhibited increased theta-power in the occipital region during CPT and Post-Stages. In the alpha-band, G2, G3, and G4 had reductions Post-Stage, while G1 and G3 increased. Additionally, beta-power increased in the frontal region for G2 and G3, contrasting with a reduction in G4. Furthermore, gamma-power globally increased during CPT1, with G1, G2, and G3 showing reductions Post-Stage, while G4 displayed a global decrease. The findings confirm the efficacy of TENS and tDCS as possible non-drug therapeutic alternatives for cognition with alleviation from pain.
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Affiliation(s)
- Muhammad Danish Mujib
- Department of Biomedical Engineering, NED University of Engineering & Technology, Karachi 75270, Pakistan; (A.Z.R.); (M.A.H.)
| | - Ahmad Zahid Rao
- Department of Biomedical Engineering, NED University of Engineering & Technology, Karachi 75270, Pakistan; (A.Z.R.); (M.A.H.)
| | - Muhammad Abul Hasan
- Department of Biomedical Engineering, NED University of Engineering & Technology, Karachi 75270, Pakistan; (A.Z.R.); (M.A.H.)
- Neurocomputation Lab, National Centre of Artificial Intelligence, NED University of Engineering & Technology, Karachi 75270, Pakistan; (H.S.); (S.A.Q.)
| | - Ayesha Ikhlaq
- Institute of Physics, The Islamia University of Bahawalpur, Bahawalpur 63100, Pakistan; (A.I.); (M.U.M.); (F.M.)
| | - Hira Shahid
- Neurocomputation Lab, National Centre of Artificial Intelligence, NED University of Engineering & Technology, Karachi 75270, Pakistan; (H.S.); (S.A.Q.)
- Research Centre for Intelligent Healthcare, Coventry University, Coventry-CV1 2TU, UK
| | - Nargis Bano
- Department of Physics and Astronomy College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
| | - Muhammad Usman Mustafa
- Institute of Physics, The Islamia University of Bahawalpur, Bahawalpur 63100, Pakistan; (A.I.); (M.U.M.); (F.M.)
| | - Faisal Mukhtar
- Institute of Physics, The Islamia University of Bahawalpur, Bahawalpur 63100, Pakistan; (A.I.); (M.U.M.); (F.M.)
| | - Mehrun Nisa
- Department of Physics, Govt. Sadiq College Women University, Bahawalpur 63100, Pakistan;
| | - Saad Ahmed Qazi
- Neurocomputation Lab, National Centre of Artificial Intelligence, NED University of Engineering & Technology, Karachi 75270, Pakistan; (H.S.); (S.A.Q.)
- Department of Electrical Engineering, NED University of Engineering & Technology, Karachi 75270, Pakistan
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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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Gurdiel-Álvarez F, González-Zamorano Y, Lerma-Lara S, Gómez-Soriano J, Sánchez-González JL, Fernández-Carnero J, Navarro-López V. Transcranial Direct Current Stimulation (tDCS) Effects on Quantitative Sensory Testing (QST) and Nociceptive Processing in Healthy Subjects: A Systematic Review and Meta-Analysis. Brain Sci 2023; 14:9. [PMID: 38275514 PMCID: PMC10813344 DOI: 10.3390/brainsci14010009] [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: 10/24/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The aim of this study is to determine the effect that different tDCS protocols have on pain processing in healthy people, assessed using quantitative sensory tests (QST) and evoked pain intensity. METHODS We systematically searched in EMBASE, CINAHL, PubMed, PEDro, PsycInfo, and Web of Science. Articles on tDCS on a healthy population and regarding QST, such as pressure pain thresholds (PPT), heat pain thresholds (HPT), cold pain threshold (CPT), or evoked pain intensity were selected. Quality was analyzed using the Cochrane Risk of Bias Tool and PEDro scale. RESULTS Twenty-six RCTs were included in the qualitative analysis and sixteen in the meta-analysis. There were no significant differences in PPTs between tDCS and sham, but differences were observed when applying tDCS over S1 in PPTs compared to sham. Significant differences in CPTs were observed between tDCS and sham over DLPFC and differences in pain intensity were observed between tDCS and sham over M1. Non-significant effects were found for the effects of tDCS on HPTs. CONCLUSION tDCS anodic over S1 stimulation increases PPTs, while a-tDCS over DLPFC affects CPTs. The HPTs with tDCS are worse. Finally, M1 a-tDCS seems to reduce evoked pain intensity in healthy subjects.
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Affiliation(s)
- Francisco Gurdiel-Álvarez
- International Doctorate School, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28933 Alcorcón, Spain; (F.G.-Á.); (Y.G.-Z.)
- Cognitive Neuroscience, Pain, and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, 28032 Madrid, Spain
| | - Yeray González-Zamorano
- International Doctorate School, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28933 Alcorcón, Spain; (F.G.-Á.); (Y.G.-Z.)
- Cognitive Neuroscience, Pain, and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, 28032 Madrid, Spain
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, 28032 Madrid, Spain;
- Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Francisco de Vitoria University, 28223 Pozuelo de Alarcón, Spain
| | - Sergio Lerma-Lara
- Department of Physical Therapy, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain;
| | - Julio Gómez-Soriano
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing, Universidad Castilla La Mancha, 45071 Toledo, Spain;
| | - Juan Luis Sánchez-González
- Faculty of Nursing and Physiotherapy, Department of Nursing and Physiotherapy, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Campus Miguel de Unamuno s/n, 37007 Salamanca, Spain;
| | - Josué Fernández-Carnero
- Cognitive Neuroscience, Pain, and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, 28032 Madrid, Spain
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, 28032 Madrid, Spain;
- La Paz Hospital Institute for Health Research, IdiPAZ, 28922 Madrid, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
| | - Víctor Navarro-López
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, 28032 Madrid, Spain;
- Movement Analysis, Biomechanics, Ergonomics, and Motor Control Laboratory, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain
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Toufexis C, Macgregor M, Lewis A, Flood A. The effects of high-definition transcranial direct current stimulation on pain modulation and stress-induced hyperalgesia. Br J Pain 2023; 17:244-254. [PMID: 37342399 PMCID: PMC10278446 DOI: 10.1177/20494637221150333] [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] [Indexed: 09/20/2023] Open
Abstract
Background The dorsolateral prefrontal cortex (DLPFC) has been implicated in the modulation of pain-related signals. Given this involvement, manipulation of the DLPFC through transcranial direct current stimulation (tDCS) may influence internal pain modulation and decrease pain sensitivity. Acute stress is also thought to affect pain, with increased pain sensitivity observed following the presentation of an acute stressor. Methods A total of 40 healthy adults (50% male), ranging in age from 19 to 28 years (M = 22.13, SD = 1.92), were randomly allocated to one of two stimulation conditions (active and sham). High-definition tDCS (HD-tDCS) was applied for 10 min at 2 mA, with the anode placed over the left DLPFC. Stress was induced after HD-tDCS administration using a modified version of the Trier Social Stress Test. Pain modulation and sensitivity were assessed through the conditioned pain modulation paradigm and pressure pain threshold measurements, respectively. Results Compared to sham stimulation, active stimulation produced a significant increase in pain modulation capacity. No significant change in pain sensitivity and stress-induced hyperalgesia was observed following active tDCS. Conclusion This research shows novel evidence that anodal HD-tDCS over the DLPFC significantly enhances pain modulation. However, HD-tDCS had no effect on pain sensitivity or stress-induced hyperalgesia. The observed effect on pain modulation after a single dose of HD-tDCS over the DLPFC is a novel finding that informs further research into the utility of HD-tDCS in the treatment of chronic pain by presenting the DLPFC as an alternative target site for tDCS-induced analgesia.
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Affiliation(s)
- Constantino Toufexis
- Faculty of Health, Discipline of Psychology, University of Canberra, Canberra, ACT, Australia
| | - Molly Macgregor
- Faculty of Health, Discipline of Psychology, University of Canberra, Canberra, ACT, Australia
| | - Aidan Lewis
- Faculty of Health, Discipline of Psychology, University of Canberra, Canberra, ACT, Australia
| | - Andrew Flood
- Faculty of Health, Discipline of Psychology, University of Canberra, Canberra, ACT, Australia
- University of Canberra Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
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Erdoğan ET, Küçük Z, Eskikurt G, Kurt A, Ermutlu N, Karamürsel S. Single Session Anodal Transcranial Direct Current Stimulation on Different Cortical Areas. J PSYCHOPHYSIOL 2022. [DOI: 10.1027/0269-8803/a000311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Transcranial direct current stimulation (tDCS) studies in healthy volunteers have shown conflicting results in terms of modulation in pain thresholds. The aim of this study was to investigate how single session anodal tDCS and modulated tDCS (mtDCS) of distinct cortical areas affected pain and perception thresholds in healthy participants. Five different stimulation conditions were applied at different cortical sites to 20 healthy volunteers to investigate the effects of tDCS and mtDCS (20 Hz) on pain and perception thresholds. TDCS over the motor cortex (M1), mtDCS over the motor cortex, tDCS over the dorsolateral prefrontal cortex (DLPFC), mtDCS of the DLPFC, and mtDCS over the occipital cortex were the stimulation conditions. All of the stimulations were anodal. The stimulations were given in a randomized order at 20-minute intervals. For comparison, electrical pain and perception thresholds were obtained from the right middle finger before and during the tDCS. After each measurement, participants were asked to give a score to their pain. In repeated measures analysis of variance (RM-ANOVA) test, the Condition × Time interaction showed no significant influence on changes in pain, perception thresholds, and pain scores ( p = .48, p = .89, and p = .50, respectively). However, regardless of the condition types, there was a significant difference in pain and perceptual thresholds during tDCS ( p = .01, p = .025, respectively). Our findings did not support difference in pain and perception modulation by a single session anodal tDCS over M1 and DLPFC compared to the occipital cortex in healthy volunteers. The increase in all thresholds during tDCS, irrespective of conditions, and peripheral sensations, including an active control group, taken together, suggest a placebo effect of active tDCS. Future studies about pain and perception in healthy subjects should consider the level of experimental pain and a strong placebo effect.
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Affiliation(s)
- Ezgi Tuna Erdoğan
- Department of Physiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Zeynep Küçük
- Department of Psychology, Faculty of Science and Literature, Halic University, Istanbul, Turkey
| | - Gökçer Eskikurt
- Department of Physiology, Faculty of Medicine, Istinye University, Istanbul, Turkey
| | - Adnan Kurt
- Department of Physiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Numan Ermutlu
- Department of Physiology, Faculty of Medicine, Istanbul Health and Technology University, Istanbul, Turkey
| | - Sacit Karamürsel
- Department of Physiology, School of Medicine, Koç University, Istanbul, Turkey
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Li X, Lin X, Yao J, Chen S, Hu Y, Liu J, Jin R. Effects of High-Definition Transcranial Direct Current Stimulation Over the Primary Motor Cortex on Cold Pain Sensitivity Among Healthy Adults. Front Mol Neurosci 2022; 15:853509. [PMID: 35370540 PMCID: PMC8971908 DOI: 10.3389/fnmol.2022.853509] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/17/2022] [Indexed: 11/13/2022] Open
Abstract
Some clinical studies have shown promising effects of transcranial direct current stimulation (tDCS) over the primary motor cortex (M1) on pain relief. Nevertheless, a few studies reported no significant analgesic effects of tDCS, likely due to the complexity of clinical pain conditions. Human experimental pain models that utilize indices of pain in response to well-controlled noxious stimuli can avoid many confounds that are present in the clinical data. This study aimed to investigate the effects of high-definition tDCS (HD-tDCS) stimulation over M1 on sensitivity to experimental pain and assess whether these effects could be influenced by the pain-related cognitions and emotions. A randomized, double-blinded, crossover, and sham-controlled design was adopted. A total of 28 healthy participants received anodal, cathodal, or sham HD-tDCS over M1 (1 mA for 20 min) in different sessions, in which montage has the advantage of producing more focal stimulation. Using a cold pressor test, several indices reflecting the sensitivity to cold pain were measured immediately after HD-tDCS stimulation, such as cold pain threshold and tolerance and cold pain intensity and unpleasantness ratings. Results showed that only anodal HD-tDCS significantly increased cold pain threshold when compared with sham stimulation. Neither anodal nor cathodal HD-tDCS showed significant analgesic effects on cold pain tolerance, pain intensity, and unpleasantness ratings. Correlation analysis revealed that individuals that a had lower level of attentional bias to negative information benefited more from attenuating pain intensity rating induced by anodal HD-tDCS. Therefore, single-session anodal HD-tDCS modulates the sensory-discriminative aspect of pain perception as indexed by the increased pain threshold. In addition, the modulating effects of HD-tDCS on attenuating pain intensity to suprathreshold pain could be influenced by the participant’s negative attentional bias, which deserves to be taken into consideration in the clinical applications.
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Affiliation(s)
- Xiaoyun Li
- School of Psychology, Shenzhen University, Shenzhen, China
| | - Xinxin Lin
- School of Psychology, Shenzhen University, Shenzhen, China
| | - Junjie Yao
- School of Psychology, Shenzhen University, Shenzhen, China
| | - Shengxiong Chen
- Medical Rehabilitation Center, Shenzhen Prevention and Treatment Center for Occupational Diseases, Shenzhen, China
| | - Yu Hu
- Medical Rehabilitation Center, Shenzhen Prevention and Treatment Center for Occupational Diseases, Shenzhen, China
| | - Jiang Liu
- Department of Computer Science and Engineering, Southern University of Science and Technology, Shenzhen, China
| | - Richu Jin
- Department of Computer Science and Engineering, Southern University of Science and Technology, Shenzhen, China
- *Correspondence: Richu Jin,
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Jiang X, Wang Y, Wan R, Feng B, Zhang Z, Lin Y, Wang Y. The effect of high-definition transcranial direct current stimulation on pain processing in a healthy population: A single-blinded crossover controlled study. Neurosci Lett 2022; 767:136304. [PMID: 34695451 DOI: 10.1016/j.neulet.2021.136304] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 12/28/2022]
Abstract
Transcranial direct current stimulation (tDCS) is increasingly used in pain treatment. tDCS targeting both primary motor cortex (M1) and dorsolateral prefrontal cortex (DLPFC) may modulate the descending pain inhibitory system, however, it remains controversial regarding the optimal stimulation region for pain modulation. Therefore, this study aimed to explore the effects of high-definition anodic stimulation of M1 and DLPFC on conditioned pain modulation (CPM) and pain thresholds and establish a preferred stimulation setting. Twenty-six healthy adults were randomly assigned to M1-tDCS, DLPFC-tDCS, or sham-tDCS groups. During the three sessions, each participant received an active or sham stimulation of 2 mA for 20 min, with at least 3 days' interval between sessions. Quantitative sensory tests were performed to obtain pressure pain threshold (PPT), cold pain threshold (CPT), and CPM before and after the tDCS intervention. Only M1-tDCS significantly increased CPM in healthy individuals compared with sham control (P = 0.004). No statistically significant difference was found in PPT and CPT between tDCS vs. sham control (P > 0.05). Our findings further support the important role of M1 as a target in pain regulation. Further large-scale, multicenter studies in chronic pain populations are needed to validate the alterations of distinct target brain regions related to pain and thus for an optimal target stimulation strategy in pain management.
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Affiliation(s)
- Xue Jiang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China; Department of Rehabilitation Medicine, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yafei Wang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ruihan Wan
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Sport Rehabilitation, Shenyang Sport University, Shenyang, China
| | - Beibei Feng
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Orthopedics & Traumatology, The University of Hong Kong, HKSAR, China
| | - Ziping Zhang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Sport Rehabilitation, Shenyang Sport University, Shenyang, China
| | - Yangyang Lin
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuling Wang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Vo L, Ilich N, Fujiyama H, Drummond PD. Anodal Transcranial Direct Current Stimulation Reduces Secondary Hyperalgesia Induced by low Frequency Electrical Stimulation in Healthy Volunteers. THE JOURNAL OF PAIN 2021; 23:305-317. [PMID: 34500109 DOI: 10.1016/j.jpain.2021.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 08/05/2021] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Abstract
The aim of the study was to determine whether transcranial direct current stimulation (tDCS) reduced pain and signs of central sensitization induced by low frequency electrical stimulation in healthy volunteers. Thirty-nine participants received tDCS stimulation under 4 different conditions: anodal tDCS of the primary motor cortex (M1), anodal tDCS of the dorsolateral prefrontal cortex (DLPFC), anodal tDCS over M1 and DLPFC concurrently, and sham tDCS. Participants were blind to the tDCS condition. The order of the conditions was randomized among participants. Pain ratings to pinpricks, the current level that evoked moderate pain, and pain induced by low frequency electrical stimulation were assessed in the forearm by an experimenter who was blind to the tDCS conditions. Anodal tDCS at M1 increased the current level that evoked moderate pain compared to sham and other conditions. Anodal tDCS of DLPFC completely abolished secondary hyperalgesia. Unexpectedly, however, concurrent anodal tDCS over M1 and DLPFC did not reduce pain or hyperalgesia more than M1 alone or DLPFC alone. Overall, these findings suggest that anodal tDCS over M1 suppresses pain, and that anodal tDCS over DLPFC modulates secondary hyperalgesia (a sign of central sensitization) in healthy participants. PERSPECTIVE: Anodal transcranial current stimulation (atDCS) at the left motor cortex and the dorsolateral prefrontal cortex increased the electrically-evoked pain threshold and reduced secondary hyperalgesia in healthy participants. Replication of this study in chronic pain populations may open more avenues for chronic pain treatment.
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Affiliation(s)
- Lechi Vo
- College of Science, Health, Engineering and Education, Discipline of Psychology Murdoch University, Perth, Australia.
| | - Nicole Ilich
- College of Science, Health, Engineering and Education, Discipline of Psychology Murdoch University, Perth, Australia
| | - Hakuei Fujiyama
- College of Science, Health, Engineering and Education, Discipline of Psychology Murdoch University, Perth, Australia
| | - Peter D Drummond
- College of Science, Health, Engineering and Education, Discipline of Psychology Murdoch University, Perth, Australia
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McPhee ME, Graven-Nielsen T. Medial Prefrontal High-Definition Transcranial Direct Current Stimulation to Improve Pain Modulation in Chronic Low Back Pain: A Pilot Randomized Double-blinded Placebo-Controlled Crossover Trial. THE JOURNAL OF PAIN 2021; 22:952-967. [PMID: 33676009 DOI: 10.1016/j.jpain.2021.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/09/2021] [Accepted: 02/19/2021] [Indexed: 06/12/2023]
Abstract
Chronic low back pain (CLBP) is highly disabling, but often without identifiable source. Focus has been on impaired anti-nociceptive mechanisms contributing to pain maintenance, though methods of targeting this impairment remain limited. This randomised-controlled cross-over pilot trial used active versus sham medial prefrontal cortex (mPFC) high-definition transcranial direct current stimulation (HD-tDCS) for 3-consecutive days to improve descending pain inhibitory function. Twelve CLBP patients were included with an average visual analogue scale (VAS) pain intensity of 3.0 ± 1.5 and pain duration of 5.3 ± 2.6 years. Pressure pain thresholds (PPTs), conditioned pain modulation (CPM), and temporal summation of pain (TSP) assessed by cuff algometry, as well as pain symptomatology (intensity, unpleasantness, quality, disability) and related psychological features (pain catastrophizing, anxiety, affect), were assessed on Day1 before 3 consecutive days of HD-tDCS sessions (each 20 minutes), at 24-hours (Day 4) and 2-weeks (Day 21) following final HD-tDCS. Blinding was successful. No significant differences in psychophysical (PPT, CPM, TSP), symptomatology or psychological outcomes were observed between active and sham HD-tDCS on Day4 and Day21. CPM-effects at Day 1 negatively correlated with change in CPM-effect at Day4 following active HD-tDCS (P = .002). Lack of efficacy was attributed to several factors, not least that patients did not display impaired CPM at baseline. TRIAL REGISTRATION: : ClinicalTrials.gov (NCT03864822). PERSPECTIVE: Medial prefrontal HD-tDCS did not alter pain, psychological nor psychophysical outcomes, though correlational analysis suggested response may depend on baseline pain inhibitory efficacy, with best potential effects in patients with severe impairments in descending pain inhibitory mechanisms. Future work should focus on appropriate patient selection and optimising stimulation targeting.
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Affiliation(s)
- Megan E McPhee
- Center for Neuroplasticity and Pain (CNAP), Aalborg University, Denmark
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10
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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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11
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Noninvasive motor cortex stimulation effects on quantitative sensory testing in healthy and chronic pain subjects: a systematic review and meta-analysis. Pain 2021; 161:1955-1975. [PMID: 32453135 DOI: 10.1097/j.pain.0000000000001893] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/01/2020] [Indexed: 02/06/2023]
Abstract
ABSTRACT One of the potential mechanisms of motor cortex stimulation by noninvasive brain stimulation (NIBS) effects on pain is through the restoration of the defective endogenous inhibitory pain pathways. However, there are still limited data on quantitative sensory testing (QST), including conditioned pain modulation (CPM), supporting this mechanism. This systematic review and meta-analysis aimed to evaluate the effects of noninvasive motor cortex stimulation on pain perception as indexed by changes in QST outcomes. Database searches were conducted until July 2019 to include randomized controlled trials that performed sham-controlled NIBS on the motor cortex in either the healthy and/or pain population and assessed the QST and CPM. Quality of studies was assessed through the Cochrane tool. We calculated the Hedge's effect sizes of QST and CPM outcomes and their 95% confidence intervals (95% CIs) and performed random-effects meta-analyses. Thirty-eight studies were included (1178 participants). We found significant increases of pain threshold in healthy subjects (ES = 0.16, 95% CI = 0.02-0.31, I2 = 22.2%) and pain populations (ES = 0.48, 95% CI = 0.15-0.80, I2 = 68.8%), and homogeneous higher CPM effect (pain ratings reduction) in healthy subjects (ES = -0.39, 95% CI = -0.64 to -0.14, I2 = 17%) and pain populations (ES = -0.35, 95% CI = -0.60 to -0.11, I2 = 0%) in the active NIBS group compared with sham. These results support the idea of top-down modulation of endogenous pain pathways by motor cortex stimulation as one of the main mechanisms of pain reduction assessed by QST, which could be a useful predictive and prognostic biomarker for chronic pain personalized treatment with NIBS.
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12
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García-Barajas G, Serrano-Muñoz D, Gómez-Soriano Pt J, Avendaño-Coy J, Fernández-Carnero J, García AM, Segura-Fragosa A, Taylor J. Efficacy of anodal suboccipital direct current stimulation for endogenous pain modulation and tonic thermal pain control in healthy participants: a randomised controlled clinical trial. PAIN MEDICINE 2021; 22:2908-2917. [PMID: 33822227 DOI: 10.1093/pm/pnab125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The aim of this study was to assess whether anodal DCS applied to the suboccipital (SO) target area could potentiate antinociception assessed primarily with conditioned pain modulation of tonic thermal test stimuli. DESIGN Randomised double-blinded control trial. SETTING Rehabilitation hospital. SUBJECTS Healthy participants. METHODS Forty healthy participants were randomized to receive either SO-DCS or M1-DCS. The 20-minute 1.5mA anodal or sham DCS intervention were applied to each participant in randomised order during two test sessions. The primary outcome measure included heterotopic cold-pressor conditioned pain modulation (CPM) of tonic heat pain. Secondary measures included pressure pain threshold and tonic thermal pain intensity. RESULTS Heterotopic CPM of tonic heat pain intensity was unaffected by either SO-DCS or active M1, including the secondary measures of pressure pain threshold and tonic thermal pain intensity. Although low-power non-significant interactions were identified for DCS intervention (active versus sham) and time (before and after), a significant within-group inhibition of tonic cold pain was identified following SO-DCS (p = 0.011, mean [SD]: -0.76±0.88 points) and M1-DCS (p < 0.002: -0.84±0.82 points), without a significant change following sham DCS. CONCLUSIONS Although heterotopic CPM was not facilitated with either SO-DCS or M1-DCS, a general significant inhibition of tonic cold pain intensity was demonstrated following both interventions. The general effects of active DCS compared to sham on tonic cold pain-irrespective of the M1 or SO target-need to be confirmed using standard quantitative sensory testing.
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Affiliation(s)
- Guillermo García-Barajas
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain.,Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Spain
| | - Diego Serrano-Muñoz
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing, Universidad Castilla La Mancha, Toledo, Spain
| | - Julio Gómez-Soriano Pt
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing, Universidad Castilla La Mancha, Toledo, Spain
| | - Juan Avendaño-Coy
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing, Universidad Castilla La Mancha, Toledo, Spain
| | - Josue Fernández-Carnero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain.,La Paz Hospital Institute for Health Research, IdiPAZ, Madrid, Spain.,Grupo Multidisciplinar de Investigación y Tratamiento del Dolor, Grupo de Excelencia Investigadora, Universidad Rey Juan Carlos-Banco de Santander, Madrid, Spain
| | - Alvaro Megía García
- Biomechanical and Technical Aids Unit, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | | | - Julian Taylor
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain.,Harris Manchester College, University of Oxford, Oxford, United Kingdom
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13
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Brasil-Neto JP, Iannone A, Caixeta FV, Cavendish BA, de Mello Cruz AP, Buratto LG. Acute offline transcranial direct current stimulation does not change pain or anxiety produced by the cold pressor test. Neurosci Lett 2020; 736:135300. [PMID: 32781010 DOI: 10.1016/j.neulet.2020.135300] [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: 04/16/2020] [Revised: 07/13/2020] [Accepted: 08/06/2020] [Indexed: 11/16/2022]
Abstract
Transcranial direct current stimulation (tDCS) over the primary motor cortex (M1) has an antalgic effect on acute experimental pain in healthy volunteers. Many published studies have used online stimulation (i.e., tDCS performed during painful stimulation). On the other hand, daily tDCS sessions have been proposed as a therapy for chronic pain (offline tDCS). In such cases, the therapeutic potential depends on the possible aftereffects of each tDCS session. We set out to investigate whether a single tDCS session before application of a classical experimental pain paradigm (the Cold Pressor Test, CPT) would be capable of modulating physiological measures of anxiety as well as pain perception. tDCS was applied to 30 healthy volunteers, 18-28 years old (mean 18.5), with the anode positioned over either the left M1 or the left dorsolateral prefrontal cortex (l-DLPFC), which has been linked to the affective aspects of experienced pain, including anxiety. All volunteers underwent the CPT procedure before and after a tDCS session. Real 2 mA tDCS sessions for 20 min were compared to sham stimulations. No significant difference was found for any variable after real tDCS sessions when compared to the sham stimulations. This result suggests that effective offline tDCS for chronic pain might have different mechanisms of action. Cumulative effects, functional targeting and the unintended simultaneous stimulation of both M1 and the l-DLPFC are likely responsible for the therapeutic effects of tDCS sessions in the clinical setting.
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Affiliation(s)
- Joaquim P Brasil-Neto
- Laboratory of Neuroscience and Behavior, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasilia, Brazil.
| | - Aline Iannone
- Laboratory of Neuroscience and Behavior, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasilia, Brazil
| | - Fabio Viegas Caixeta
- Laboratory of Neuroscience and Behavior, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasilia, Brazil
| | - Beatriz Araújo Cavendish
- Institute of Psychology, Department of Basic Psychological Processes, University of Brasilia, Brazil
| | | | - Luciano Grüdtner Buratto
- Institute of Psychology, Department of Basic Psychological Processes, University of Brasilia, Brazil
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14
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Borovskis J, Cavaleri R, Blackstock F, Summers SJ. Transcranial Direct Current Stimulation Accelerates The Onset of Exercise-Induced Hypoalgesia: A Randomized Controlled Study. THE JOURNAL OF PAIN 2020; 22:263-274. [PMID: 32927091 DOI: 10.1016/j.jpain.2020.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/09/2020] [Accepted: 08/24/2020] [Indexed: 02/06/2023]
Abstract
Exercise-induced hypoalgesia (EIH) describes acute reductions in pain that occur following exercise. Current evidence suggests that the magnitude of EIH is small-to-moderate at best, warranting exploration of novel avenues to bolster these effects. Transcranial direct current stimulation (tDCS) has been shown to relieve pain and represents a promising intervention that may enhance EIH. This study aimed to determine whether anodal tDCS of the primary motor cortex (M1) can augment EIH in healthy individuals experiencing experimentally-induced musculoskeletal pain. Twenty-four healthy subjects attended 2 experimental sessions ("Day 0" and "Day 2"). On Day 0, subjects were injected with nerve growth factor into their right extensor carpi radialis brevis to induce persistent elbow pain. On Day 2, each subject received active or sham tDCS over M1 followed by an isometric grip exercise. Pain intensity, muscle soreness, sensitivity (pressure pain thresholds), and conditioned pain modulation were assessed prior to the nerve growth factor injection, on Day 2 before tDCS, immediately post-exercise, and 15 minutes post-exercise. Active tDCS expedited the onset of EIH, inducing immediate reductions in pain intensity that were not present until 15 minutes post-exercise in the sham group. However, active tDCS did not reduce muscle soreness or sensitivity when compared to sham tDCS. PERSPECTIVE: These findings suggest that active tDCS accelerates the onset of EIH in healthy individuals experiencing experimentally-induced pain. This may represent a promising means of enhancing adherence to exercise protocols. However, larger randomised controlled trials in persistent pain populations are required to confirm the clinical impact of these findings.
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Affiliation(s)
- Jana Borovskis
- School of Health Sciences, Western Sydney University, NSW 2560, Australia; Brain Stimulation and Rehabilitation (BrainStAR) Lab, Western Sydney University, NSW 2560, Australia
| | - Rocco Cavaleri
- School of Health Sciences, Western Sydney University, NSW 2560, Australia; Brain Stimulation and Rehabilitation (BrainStAR) Lab, Western Sydney University, NSW 2560, Australia
| | | | - Simon J Summers
- School of Health Sciences, Western Sydney University, NSW 2560, Australia; Brain Stimulation and Rehabilitation (BrainStAR) Lab, Western Sydney University, NSW 2560, Australia; Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, ACT 2617, Australia; Research School of Biology, Australian National University, ACT 2600, Australia.
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15
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Saldanha JS, Zortea M, Deliberali CB, Nitsche MA, Kuo MF, Torres ILDS, Fregni F, Caumo W. Impact of Age on tDCS Effects on Pain Threshold and Working Memory: Results of a Proof of Concept Cross-Over Randomized Controlled Study. Front Aging Neurosci 2020; 12:189. [PMID: 32714178 PMCID: PMC7344165 DOI: 10.3389/fnagi.2020.00189] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/02/2020] [Indexed: 12/17/2022] Open
Abstract
Background: Age is an important factor that impacts the variability of tDCS effects. Objective/Hypothesis: To compare effects of anodal (a)-tDCS over the left dorsolateral prefrontal cortex (DLPFC), and primary motor cortex (M1) in adolescents, adults, and elderly on heat pain threshold (HPT; primary outcome) and the working memory (WM; secondary outcome). We hypothesized that the effect of tDCS on HPT and WM performance would be the largest in adolescents because their pre-frontal cortex is more prone to neuroplasticity. Methods: We included 30 healthy women within the age ranges of 15–16 (adolescents, n = 10), 30–40 (adults, n = 10), and 60–70 (elderly, n = 10) years. In this crossover single-blinded study, participants received three interventions applied over the DLPF and M1. The active stimulation intensity was two mA for 30 min. From 20 min of stimulation onset, the tDCS session was coupled with an online n-back task. The a-tDCS and sham were applied in a random sequence, with a washout time of a minimum 7 days between each trial. HPT was evaluated before and after stimulation. The WM performance with an n-back task was assessed after the tDCS session. Results: A Generalized Estimating Equation (GEE) model revealed a significant effect of the a-tDCS over the left DLPFC to reduce the HPT in adolescents compared with sham. It increased the pain perception significantly [a large effect size (ES) of 1.09)]. In the adults, a-tDCS over M1 enhanced the HPT significantly (a large ES of 1.25) compared to sham. No significant effect for HPT was found in the elderly. Response time for hits was reduced for a-tDCS over the DLPFC in adolescents, as compared to the other two age groups. Conclusions: These findings suggest that a-tDCS modulates pain perception and WM differentially according to age and target area of stimulation. In adolescents, anodal stimulation over the DLPFC increased the pain perception, while in adults, the stimulation over the M1 increased the pain threshold. Thus, they elucidate the impact of tDCS for different age groups and can help to define what is the appropriate intervention according to age in further clinical trials. Clinical Trial Registration:www.ClinicalTrials.gov, Identifier: NCT04328545.
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Affiliation(s)
- Júlia Schirmer Saldanha
- Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Laboratory of Pain & Neuromodulation, Clinical Research Center, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Maxciel Zortea
- Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Laboratory of Pain & Neuromodulation, Clinical Research Center, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Cibely Bavaresco Deliberali
- Laboratory of Pain & Neuromodulation, Clinical Research Center, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Michael A Nitsche
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.,Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
| | - Min-Fang Kuo
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Iraci Lucena da Silva Torres
- Department of Pharmacology, Instituto de Ciências Básicas da Saúde, 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
- Laboratory of Neuromodulation and Center for Clinical Research Learning, Physics and Rehabilitation Department, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Wolnei Caumo
- Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Laboratory of Pain & Neuromodulation, Clinical Research Center, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Pain and Palliative Care Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Department of Surgery, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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16
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Henriques IAD, Lattari E, Torres G, Rodrigues GM, Oliveira BRR, Neto GAM, Neto SRM, Machado S. Can transcranial direct current stimulation improve range of motion and modulate pain perception in healthy individuals? Neurosci Lett 2019; 707:134311. [PMID: 31158433 DOI: 10.1016/j.neulet.2019.134311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 12/16/2022]
Abstract
The objective of the present study was to investigate the effects of different electrode assemblies and electric current polarity on the ROM of the hip and pain perception. Ten healthy male, sedentary, right-leg-dominant, and aged between 19 and 30 years (24.0 ± 4.0 years) subjects were recruited. For the experimental conditions, the application of transcranial direct current stimulation (tDCS) was performed with the following montages. In the montage 1, the cathodal electrode was placed over the motor cortex (MC) horizontally, and the anodal electrode was positioned over the left dorsolateral prefrontal cortex (DLPFC). In the montage 2, the anodal electrode was placed over the MC bilaterally, and the cathode electrode was positioned over the left DLPFC. The sham montage was the same as the montage 1. In the montage 1 and 2 stimulation was applied with 2 mA current intensity for 20 min. In the Sham condition, the stimulator was turned off after 30 s of active stimulation and the electrodes remained on the participants for 20 min. Before and after experimental conditions (Pre-stimulation, Post-stimulation), the maximum Hip ROM and pain perception was measured. For the Montage 1, the maximum Hip ROM increased in post-stimulation compared to pre-stimulation, and in the Montage 2, the maximum Hip ROM decreased in post-stimulation compared to pre-stimulation. The pain perception in the Montage 1 decreased in the post-stimulation compared to pre-stimulation. In the post-stimulation, pain perception for the Montage 1 was lower compared to Montage 2 (p = 0.005), and sham (p = 0.004). When the anodic stimulus was applied on the left DLPFC and the cathodic stimulus on the motor cortex, an increase in ROM and a reduction in the pain perception was observed. This montage may to modulate pain perception and joint flexibility.
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Affiliation(s)
- Ighor Amadeu Dias Henriques
- Physical Activity Sciences Postgraduate Program - Salgado de Oliveira University (UNIVERSO), Niterói, Brazil
| | - Eduardo Lattari
- Physical Activity Sciences Postgraduate Program - Salgado de Oliveira University (UNIVERSO), Niterói, Brazil
| | - Gabriela Torres
- Physical Activity Sciences Postgraduate Program - Salgado de Oliveira University (UNIVERSO), Niterói, Brazil
| | - Guilherme Moraes Rodrigues
- Physical Activity Sciences Postgraduate Program - Salgado de Oliveira University (UNIVERSO), Niterói, Brazil
| | | | | | | | - Sérgio Machado
- Laboratory of Physical Activity Neuroscience, Physical Activity Sciences Postgraduate Program - Salgado de Oliveira University (UNIVERSO), Niterói, Brazil.
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17
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Park SB, Sung DJ, Kim B, Kim S, Han JK. Transcranial Direct Current Stimulation of motor cortex enhances running performance. PLoS One 2019; 14:e0211902. [PMID: 30794568 PMCID: PMC6386265 DOI: 10.1371/journal.pone.0211902] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/22/2019] [Indexed: 11/18/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a technique used to modulate neuronal excitability through non-invasive brain stimulation that can enhance exercise performance. We hypothesize that tDCS would improve submaximal running time to exhaustion (TTE) and delay the increase in the rating of perceived exertion (RPE) over time. We also hypothesize that tDCS would not lead to difference in cardiorespiratory responses. We employed a randomized, single-blinded, and counterbalanced design in which 10 trained men participated. After receiving either 20 min of 1.98 mA anodal tDCS applied over the primary motor cortex (M1) or sham-operated control on separate days, participants completed a constant-load test involving running at a speed equivalent to 80% of their own maximum oxygen consumption (VO2max). During this constant-load test, RPE, heart rate (HR), VO2, pulmonary ventilation (VE), respiratory exchange ratio (RER), and ventilatory threshold (VT) were continuously monitored. TTE was recorded at the end of the test. TTEs were significantly longer in the tDCS than in the sham conditions (21.18 ± 7.13 min; 18.44 ± 6.32 min; p = 0.011). For TTE, no significant differences were found in RPE between conditions at isotime. In addition, no significant differences in HR, VO2, VE, RER, and VT were found during TTE between the two stimulation conditions at any time point. These results indicate that the application of tDCS does not induce a change of the exercise performance-related index; however, it can affect the increase of the exercise duration due to the stimuli in the M1 area.
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Affiliation(s)
- Seung-Bo Park
- Department of Physiology, KU Open Innovation Center, Research Institute of Medical Science, Konkuk University School of Medicine, Chungju, Chungbuk, South Korea
| | - Dong Jun Sung
- Division of Sport and Health Science, College of Biomedical and Health Science, Konkuk University, Chungju, Chungbuk, South Korea
| | - Bokyung Kim
- Department of Physiology, KU Open Innovation Center, Research Institute of Medical Science, Konkuk University School of Medicine, Chungju, Chungbuk, South Korea
| | - SoJung Kim
- Department of Physical Therapy and Kinesiology, Zuckerberg, College of Health Sciences, University of Massachusetts, Lowell, Massachusetts, United States of America
| | - Joung-Kyue Han
- College of Sport Sciences, Chung-Ang University, Anseong, Gyoenggi, South Korea
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18
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19
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Angius L, Mauger AR, Hopker J, Pascual-Leone A, Santarnecchi E, Marcora SM. Bilateral extracephalic transcranial direct current stimulation improves endurance performance in healthy individuals. Brain Stimul 2017; 11:108-117. [PMID: 29079458 DOI: 10.1016/j.brs.2017.09.017] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 09/28/2017] [Accepted: 09/30/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) has been used to enhance endurance performance but its precise mechanisms and effects remain unknown. OBJECTIVE To investigate the effect of bilateral tDCS on neuromuscular function and performance during a cycling time to task failure (TTF) test. METHODS Twelve participants in randomized order received a placebo tDCS (SHAM) or real tDCS with two cathodes (CATHODAL) or two anodes (ANODAL) over bilateral motor cortices and the opposite electrode pair over the ipsilateral shoulders. Each session lasted 10 min and current was set at 2 mA. Neuromuscular assessment was performed before and after tDCS and was followed by a cycling time to task failure (TTF) test. Heart rate (HR), ratings of perceived exertion (RPE), leg muscle pain (PAIN) and blood lactate accumulation (ΔB[La-]) in response to the cycling TTF test were measured. RESULTS Corticospinal excitability increased in the ANODAL condition (P < 0.001) while none of the other neuromuscular parameters showed any change. Neuromuscular parameters did not change in the SHAM and CATHODAL conditions. TTF was significantly longer in the ANODAL (P = 0.003) compared to CATHODAL and SHAM conditions (12.61 ± 4.65 min; 10.61 ± 4.34 min; 10.21 ± 3.47 min respectively), with significantly lower RPE and higher ΔB[La-] (P < 0.001). No differences between conditions were found for HR (P = 0.803) and PAIN during the cycling TTF test (P = 0.305). CONCLUSION Our findings demonstrate that tDCS with the anode over both motor cortices using a bilateral extracephalic reference improves endurance performance.
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Affiliation(s)
- L Angius
- Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Chatham Maritime, UK
| | - A R Mauger
- Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Chatham Maritime, UK.
| | - J Hopker
- Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Chatham Maritime, UK
| | - 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
| | - 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
| | - S M Marcora
- Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Chatham Maritime, UK
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Effects of transcranial direct current stimulation on temperature and pain perception. Sci Rep 2017; 7:2946. [PMID: 28592857 PMCID: PMC5462761 DOI: 10.1038/s41598-017-03173-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 04/24/2017] [Indexed: 11/22/2022] Open
Abstract
Transcranial direct current stimulation modifies cortical excitability and in consequence some cerebral functions. In the present study we aimed to elucidate whether tDCS could affect temperature and pain perceptions in healthy subjects testing different stimulation parameters. A total of 20 healthy subjects were studied by means of quantitative sensory testing. Two different experiments were performed. First, we studied the effects of 15 minutes 2 mA anodal transcranial direct current stimulation applied over left M1 and parietal cortex in two separated sessions. Then, we tested the effects of 5 minutes tDCS over M1 by means of a sham controlled design to optimize the possibility to study minimal effects of tDCS using different polarities (cathodal and anodal) and intensities (1 and 2 mA). 2 mA anodal tDCS, when applied for both 15 and 5 minutes over the motor cortex, increased cold perception threshold. Conversely, motor cortex cathodal tDCS modulated cold perception threshold only when 1 mA intensity was used. M1-tDCS can modify the temperature perception; these effects are polarity and intensity dependent. As stimulation intensity seems critical to determine the effects, we suggest that for clinical application strong anodal tDCS (>1 mA) or weak cathodal tDCS (<2 mA) should be used for pain control.
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Palm U, Chalah MA, Padberg F, Al-Ani T, Abdellaoui M, Sorel M, Dimitri D, Créange A, Lefaucheur JP, Ayache SS. Effects of transcranial random noise stimulation (tRNS) on affect, pain and attention in multiple sclerosis. Restor Neurol Neurosci 2016; 34:189-99. [PMID: 26890095 DOI: 10.3233/rnn-150557] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Pain and cognitive impairment are frequent symptoms in patients with multiple sclerosis (MS). Neglecting experimental pain and paying attention to demanding tasks is reported to decrease the pain intensity. Little is known about the interaction between chronic neuropathic pain and attention disorders in MS. Recently, transcranial direct current stimulation (tDCS) was used to modulate various cognitive and motor symptoms in MS. We aimed to study the effects of transcranial random noise stimulation (tRNS), a form of transcranial electric stimulation, over the left dorsolateral prefrontal cortex (DLPFC) on attention and neuropathic pain in MS patients. METHODS 16 MS patients were included in a randomized, sham-controlled, cross-over study. Each patient randomly received two tRNS blocks, separated by three weeks of washout interval. Each block consisted of three consecutive daily sessions of either active or sham tRNS. The patients were evaluated for pain, attention and mood and further underwent an electrophysiological evaluation. RESULTS Compared to sham, tRNS showed a trend to decrease the N2-P2 amplitudes of pain related evoked potentials and improve pain ratings. Attention performance and mood scales did not change after stimulations. CONCLUSIONS This study suggests the role of tRNS in pain modulation, which could have been more evident with longer stimulation protocols.
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Affiliation(s)
- Ulrich Palm
- Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France.,Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University Munich, Munich, Germany
| | - Moussa A Chalah
- Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France.,EA 4391, Nerve Excitability and Therapeutic Team, Faculty of Medicine, Paris Est Créteil University, Créteil, France
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University Munich, Munich, Germany
| | - Tarik Al-Ani
- EA 4391, Nerve Excitability and Therapeutic Team, Faculty of Medicine, Paris Est Créteil University, Créteil, France
| | - Mohamed Abdellaoui
- Department of Neurology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Marc Sorel
- EA 4391, Nerve Excitability and Therapeutic Team, Faculty of Medicine, Paris Est Créteil University, Créteil, France
| | - Dalia Dimitri
- Department of Neurology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Alain Créange
- EA 4391, Nerve Excitability and Therapeutic Team, Faculty of Medicine, Paris Est Créteil University, Créteil, France.,Department of Neurology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Jean-Pascal Lefaucheur
- Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France.,EA 4391, Nerve Excitability and Therapeutic Team, Faculty of Medicine, Paris Est Créteil University, Créteil, France
| | - Samar S Ayache
- Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France.,EA 4391, Nerve Excitability and Therapeutic Team, Faculty of Medicine, Paris Est Créteil University, Créteil, France
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Transcranial direct current stimulation (tDCS) neuromodulatory effects on mechanical hyperalgesia and cortical BDNF levels in ovariectomized rats. Life Sci 2016; 145:233-9. [DOI: 10.1016/j.lfs.2015.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 10/07/2015] [Accepted: 10/10/2015] [Indexed: 02/02/2023]
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Nakagawa K, Mochizuki H, Koyama S, Tanaka S, Sadato N, Kakigi R. A transcranial direct current stimulation over the sensorimotor cortex modulates the itch sensation induced by histamine. Clin Neurophysiol 2016; 127:827-832. [DOI: 10.1016/j.clinph.2015.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 07/02/2015] [Accepted: 07/05/2015] [Indexed: 10/23/2022]
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Angius L, Hopker JG, Marcora SM, Mauger AR. The effect of transcranial direct current stimulation of the motor cortex on exercise-induced pain. Eur J Appl Physiol 2015; 115:2311-9. [PMID: 26148882 DOI: 10.1007/s00421-015-3212-y] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 06/28/2015] [Indexed: 12/21/2022]
Abstract
PURPOSE Transcranial direct current stimulation (tDCS) provides a new exciting means to investigate the role of the brain during exercise. However, this technique is not widely used in exercise science, with little known regarding effective electrode montages. This study investigated whether tDCS of the motor cortex (M1) would elicit an analgesic response to exercise-induced pain (EIP). METHODS Nine participants completed a VO2max test and three time to exhaustion (TTE) tasks on separate days following either 10 min 2 mA tDCS of the M1, a sham or a control. Additionally, seven participants completed 3 cold pressor tests (CPT) following the same experimental conditions (tDCS, SHAM, CON). Using a well-established tDCS protocol, tDCS was delivered by placing the anodal electrode above the left M1 with the cathodal electrode above dorsolateral right prefrontal cortex. Gas exchange, blood lactate, EIP and ratings of perceived exertion (RPE) were monitored during the TTE test. Perceived pain was recorded during the CPT. RESULTS During the TTE, no significant differences in time to exhaustion, RPE or EIP were found between conditions. However, during the CPT, perceived pain was significantly (P < 0.05) reduced in the tDCS condition (7.4 ± 1.2) compared with both the CON (8.6 ± 1.0) and SHAM (8.4 ± 1.3) conditions. CONCLUSION These findings demonstrate that stimulation of the M1 using tDCS does not induce analgesia during exercise, suggesting that the processing of pain produced via classic measures of experimental pain (i.e., a CPT) is different to that of EIP. These results provide important methodological advancement in developing the use of tDCS in exercise.
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Affiliation(s)
- Luca Angius
- Endurance Research Group, School of Sport and Exercise Sciences, Faculty of Science, University of Kent, Chatham Maritime, Kent, ME4 4AG, UK
| | - James G Hopker
- Endurance Research Group, School of Sport and Exercise Sciences, Faculty of Science, University of Kent, Chatham Maritime, Kent, ME4 4AG, UK
| | - Samuele M Marcora
- Endurance Research Group, School of Sport and Exercise Sciences, Faculty of Science, University of Kent, Chatham Maritime, Kent, ME4 4AG, UK
| | - Alexis R Mauger
- Endurance Research Group, School of Sport and Exercise Sciences, Faculty of Science, University of Kent, Chatham Maritime, Kent, ME4 4AG, UK.
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Shin YI, Foerster Á, Nitsche MA. Reprint of: Transcranial direct current stimulation (tDCS) – Application in neuropsychology. Neuropsychologia 2015; 74:74-95. [DOI: 10.1016/j.neuropsychologia.2015.06.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 01/29/2015] [Accepted: 02/02/2015] [Indexed: 01/07/2023]
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26
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Fregni F, Nitsche MA, Loo CK, Brunoni AR, Marangolo P, Leite J, Carvalho S, Bolognini N, Caumo W, Paik NJ, Simis M, Ueda K, Ekhitari H, Luu P, Tucker DM, Tyler WJ, Brunelin J, Datta A, Juan CH, Venkatasubramanian G, Boggio PS, Bikson M. Regulatory Considerations for the Clinical and Research Use of Transcranial Direct Current Stimulation (tDCS): review and recommendations from an expert panel. CLINICAL RESEARCH AND REGULATORY AFFAIRS 2015; 32:22-35. [PMID: 25983531 PMCID: PMC4431691 DOI: 10.3109/10601333.2015.980944] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The field of transcranial electrical stimulation (tES) has experienced significant growth in the past 15 years. One of the tES techniques leading this increased interest is transcranial direct current stimulation (tDCS). Significant research efforts have been devoted to determining the clinical potential of tDCS in humans. Despite the promising results obtained with tDCS in basic and clinical neuroscience, further progress has been impeded by a lack of clarity on international regulatory pathways. We therefore convened a group of research and clinician experts on tDCS to review the research and clinical use of tDCS. In this report, we review the regulatory status of tDCS, and we summarize the results according to research, off-label and compassionate use of tDCS in the following countries: Australia, Brazil, France, Germany, India, Iran, Italy, Portugal, South Korea, Taiwan and United States. Research use, off label treatment and compassionate use of tDCS are employed in most of the countries reviewed in this study. It is critical that a global or local effort is organized to pursue definite evidence to either approve and regulate or restrict the use of tDCS in clinical practice on the basis of adequate randomized controlled treatment trials.
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Affiliation(s)
- F Fregni
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - M A Nitsche
- Department of Clinical Neurophysiology, Georg-August-University, Göttingen, Germany
| | - C K Loo
- School of Psychiatry & The Black Dog Institute, University of New South Wales, Sydney, Australia
| | - A R Brunoni
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil and Division of Neurology, Santa Casa Medicak School, Sao Paulo, Brazil
| | - P Marangolo
- Department of Experimental and Clinical Medicine, University Politecnica delle Marche, Ancona, and IRCCS Fondazione Santa Lucia, Roma, Italy
| | - J Leite
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA ; Neuropsychophysiology Laboratory, CIPsi, School of Psychology (EPsi), University of Minho, Campus de Gualtar, Braga, Portugal
| | - S Carvalho
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA ; Neuropsychophysiology Laboratory, CIPsi, School of Psychology (EPsi), University of Minho, Campus de Gualtar, Braga, Portugal
| | - N Bolognini
- Department of Psychology, University of Milano Bicocca, and Laboratory of Neuropsychology, IRCC Instituto Auxologico Italiano, Milano, Italy
| | - W Caumo
- Laboratory of Pain & Neuromodulation at Hospital de Clínicas de Porto Alegre at UFRGS
| | - N J Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - M Simis
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil and Division of Neurology, Santa Casa Medicak School, Sao Paulo, Brazil
| | - K Ueda
- National Cardiovascular Center, Osaka, Japan
| | - H Ekhitari
- Translational Neuroscience Program, Institute for Cognitive Science Studies, Tehran, Iran ; Neurocognitive Laboratory, Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - P Luu
- Electrical Geodesics, Inc., and University of Oregon, Eugene, Oregon, USA
| | - D M Tucker
- Electrical Geodesics, Inc., and University of Oregon, Eugene, Oregon, USA
| | - W J Tyler
- Virginia Tech Carilion Research Institute, Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, and School of Biomedical Engineering and Sciences, Virginia Tech, Roanoke, VA USA
| | - J Brunelin
- EA 4615, Centre Hospitalier le Vinatier, Université de Lyon, F-69003, Université Claude Bernard Lyon I, Bron, France
| | - A Datta
- Department of Biomedical Engineering, Neural Engineering Laboratory, The City College of the City University of New York New York, NY, USA
| | - C H Juan
- Institute of Cognitive Neuroscience, National Central University, Taiwan
| | - G Venkatasubramanian
- Translational Psychiatry Laboratory, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - P S Boggio
- Social and Cognitive Neuroscience Laboratory and Developmental Disorders Program, Center for Healthy and Biological Sciences, Mackenzie Presbyterian University, Sao Paulo, Brazil
| | - M Bikson
- Department of Biomedical Engineering, Neural Engineering Laboratory, The City College of the City University of New York New York, NY, USA
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Transcranial direct current stimulation (tDCS) – Application in neuropsychology. Neuropsychologia 2015; 69:154-75. [DOI: 10.1016/j.neuropsychologia.2015.02.002] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 01/29/2015] [Accepted: 02/02/2015] [Indexed: 12/21/2022]
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Rampersad SM, Janssen AM, Lucka F, Aydin Ü, Lanfer B, Lew S, Wolters CH, Stegeman DF, Oostendorp TF. Simulating transcranial direct current stimulation with a detailed anisotropic human head model. IEEE Trans Neural Syst Rehabil Eng 2014; 22:441-52. [PMID: 24760939 DOI: 10.1109/tnsre.2014.2308997] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique able to induce long-lasting changes in cortical excitability that can benefit cognitive functioning and clinical treatment. In order to both better understand the mechanisms behind tDCS and possibly improve the technique, finite element models are used to simulate tDCS of the human brain. With the detailed anisotropic head model presented in this study, we provide accurate predictions of tDCS in the human brain for six of the practically most-used setups in clinical and cognitive research, targeting the primary motor cortex, dorsolateral prefrontal cortex, inferior frontal gyrus, occipital cortex, and cerebellum. We present the resulting electric field strengths in the complete brain and introduce new methods to evaluate the effectivity in the target area specifically, where we have analyzed both the strength and direction of the field. For all cerebral targets studied, the currently accepted configurations produced sub-optimal field strengths. The configuration for cerebellum stimulation produced relatively high field strengths in its target area, but it needs higher input currents than cerebral stimulation does. This study suggests that improvements in the effects of transcranial direct current stimulation are achievable.
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