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Montilla-Herrador J, Lozano-Meca J, Lozano-Guadalajara JV, Gacto-Sánchez M. The Efficacy of the Addition of tDCS and TENS to an Education and Exercise Program in Subjects with Knee Osteoarthritis: A Randomized Controlled Trial. Biomedicines 2024; 12:1186. [PMID: 38927392 PMCID: PMC11200463 DOI: 10.3390/biomedicines12061186] [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: 05/04/2024] [Revised: 05/17/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024] Open
Abstract
Knee osteoarthritis (KOA) has a significant impact on patients' quality of life. This study aimed to assess the effectiveness of integrating transcranial direct current stimulation (tDCS) and transcutaneous electrical nerve stimulation (TENS) into an education and exercise program with the aim of decreasing pain and improving physical function in KOA. A randomized controlled trial with 65 KOA patients was conducted. The subjects were assigned to one of the following three groups: education and active exercise plus (1) double active tDCS and TENS, (2) active tDCS and sham TENS, and (3) double sham tDCS and TENS. Sessions were conducted over a 20 min period, whilst data on pain, chronic pain clinical variables, and physical function were collected. Although all groups showed improvement in pain-related symptoms in the short and medium term, the addition of tDCS and/or TENS did not significantly enhance the benefits of the exercise and education program. These findings suggest that an education and active exercise program in the treatment of KOA has a positive effect on pain, with or without the addition of tDCS and/or TENS.
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Affiliation(s)
- Joaquina Montilla-Herrador
- Department of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum, University of Murcia, Instituto de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB), El Palmar, 30120 Murcia, Spain; (J.M.-H.); (M.G.-S.)
| | - Jose Lozano-Meca
- Department of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum, University of Murcia, Instituto de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB), El Palmar, 30120 Murcia, Spain; (J.M.-H.); (M.G.-S.)
| | | | - Mariano Gacto-Sánchez
- Department of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum, University of Murcia, Instituto de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB), El Palmar, 30120 Murcia, Spain; (J.M.-H.); (M.G.-S.)
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2
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Kummer K, Sheets PL. Targeting Prefrontal Cortex Dysfunction in Pain. J Pharmacol Exp Ther 2024; 389:268-276. [PMID: 38702195 PMCID: PMC11125798 DOI: 10.1124/jpet.123.002046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/12/2024] [Accepted: 04/02/2024] [Indexed: 05/06/2024] Open
Abstract
The prefrontal cortex (PFC) has justifiably become a significant focus of chronic pain research. Collectively, decades of rodent and human research have provided strong rationale for studying the dysfunction of the PFC as a contributing factor in the development and persistence of chronic pain and as a key supraspinal mechanism for pain-induced comorbidities such as anxiety, depression, and cognitive decline. Chronic pain alters the structure, chemistry, and connectivity of PFC in both humans and rodents. In this review, we broadly summarize the complexities of reported changes within both rodent and human PFC caused by pain and offer insight into potential pharmacological and nonpharmacological approaches for targeting PFC to treat chronic pain and pain-associated comorbidities. SIGNIFICANCE STATEMENT: Chronic pain is a significant unresolved medical problem causing detrimental changes to physiological, psychological, and behavioral aspects of life. Drawbacks of currently approved pain therapeutics include incomplete efficacy and potential for abuse producing a critical need for novel approaches to treat pain and comorbid disorders. This review provides insight into how manipulation of prefrontal cortex circuits could address this unmet need of more efficacious and safer pain therapeutics.
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Affiliation(s)
- Kai Kummer
- Institute of Physiology, Medical University of Innsbruck, Innsbruck, Austria (K.K.); Department of Pharmacology and Toxicology (P.L.S.), Medical Neurosciences Graduate Program (P.L.S.), and Stark Neurosciences Research Institute (P.L.S.), Indiana University School of Medicine, Indianapolis, Indiana
| | - Patrick L Sheets
- Institute of Physiology, Medical University of Innsbruck, Innsbruck, Austria (K.K.); Department of Pharmacology and Toxicology (P.L.S.), Medical Neurosciences Graduate Program (P.L.S.), and Stark Neurosciences Research Institute (P.L.S.), Indiana University School of Medicine, Indianapolis, Indiana
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3
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Ester-Nacke T, Berti K, Veit R, Dannecker C, Salvador R, Ruffini G, Heni M, Birkenfeld AL, Plewnia C, Preissl H, Kullmann S. Network-targeted transcranial direct current stimulation of the hypothalamus appetite-control network: a feasibility study. Sci Rep 2024; 14:11341. [PMID: 38762574 PMCID: PMC11102513 DOI: 10.1038/s41598-024-61852-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 05/10/2024] [Indexed: 05/20/2024] Open
Abstract
The hypothalamus is the key regulator for energy homeostasis and is functionally connected to striatal and cortical regions vital for the inhibitory control of appetite. Hence, the ability to non-invasively modulate the hypothalamus network could open new ways for the treatment of metabolic diseases. Here, we tested a novel method for network-targeted transcranial direct current stimulation (net-tDCS) to influence the excitability of brain regions involved in the control of appetite. Based on the resting-state functional connectivity map of the hypothalamus, a 12-channel net-tDCS protocol was generated (Neuroelectrics Starstim system), which included anodal, cathodal and sham stimulation. Ten participants with overweight or obesity were enrolled in a sham-controlled, crossover study. During stimulation or sham control, participants completed a stop-signal task to measure inhibitory control. Overall, stimulation was well tolerated. Anodal net-tDCS resulted in faster stop signal reaction time (SSRT) compared to sham (p = 0.039) and cathodal net-tDCS (p = 0.042). Baseline functional connectivity of the target network correlated with SSRT after anodal compared to sham stimulation (p = 0.016). These preliminary data indicate that modulating hypothalamus functional network connectivity via net-tDCS may result in improved inhibitory control. Further studies need to evaluate the effects on eating behavior and metabolism.
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Affiliation(s)
- Theresa Ester-Nacke
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.
- Department of Internal Medicine, Division of Endocrinology, Diabetology and Nephrology, Eberhard Karls University Tübingen, Tübingen, Germany.
- German Center of Diabetes Research (DZD), Tübingen, Germany.
| | - Katharina Berti
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
- Department of Internal Medicine, Division of Endocrinology, Diabetology and Nephrology, Eberhard Karls University Tübingen, Tübingen, Germany
- German Center of Diabetes Research (DZD), Tübingen, Germany
| | - Ralf Veit
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
- Department of Internal Medicine, Division of Endocrinology, Diabetology and Nephrology, Eberhard Karls University Tübingen, Tübingen, Germany
- German Center of Diabetes Research (DZD), Tübingen, Germany
| | - Corinna Dannecker
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
- Department of Internal Medicine, Division of Endocrinology, Diabetology and Nephrology, Eberhard Karls University Tübingen, Tübingen, Germany
- German Center of Diabetes Research (DZD), Tübingen, Germany
| | | | | | - Martin Heni
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
- Department of Internal Medicine, Division of Endocrinology, Diabetology and Nephrology, Eberhard Karls University Tübingen, Tübingen, Germany
- German Center of Diabetes Research (DZD), Tübingen, Germany
- Department for Diagnostic Laboratory Medicine, Institute for Clinical Chemistry and Pathobiochemistry, Eberhard Karls University Tübingen, Tübingen, Germany
- Division of Endocrinology and Diabetology, Department of Internal Medicine 1, University Hospital Ulm, Ulm, Germany
| | - Andreas L Birkenfeld
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
- Department of Internal Medicine, Division of Endocrinology, Diabetology and Nephrology, Eberhard Karls University Tübingen, Tübingen, Germany
- German Center of Diabetes Research (DZD), Tübingen, Germany
| | - Christian Plewnia
- Department of Psychiatry and Psychotherapy, German Center for Mental Health (DZPG), Neurophysiology and Interventional Neuropsychiatry, University Hospital Tübingen, Tübingen, Germany
| | - Hubert Preissl
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
- Department of Internal Medicine, Division of Endocrinology, Diabetology and Nephrology, Eberhard Karls University Tübingen, Tübingen, Germany
- German Center of Diabetes Research (DZD), Tübingen, Germany
| | - Stephanie Kullmann
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
- Department of Internal Medicine, Division of Endocrinology, Diabetology and Nephrology, Eberhard Karls University Tübingen, Tübingen, Germany
- German Center of Diabetes Research (DZD), Tübingen, Germany
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Yadollahpour A, Rashidi S, Saki N, Kunwar PS, Mayo-Yáñez M. Repeated Bilateral Transcranial Direct Current Stimulation over Auditory Cortex for Tinnitus Treatment: A Double-Blinded Randomized Controlled Clinical Trial. Brain Sci 2024; 14:373. [PMID: 38672022 PMCID: PMC11048041 DOI: 10.3390/brainsci14040373] [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: 08/12/2023] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive and painless technique of brain neuromodulation that applies a low-intensity galvanic current to the scalp with the aim of stimulating specific areas of the brain. Preliminary investigations have indicated the potential therapeutic efficacy of multisession tDCS applied to the auditory cortex (AC) in the treatment of chronic tinnitus. The aim of this study was to explore the therapeutic effects of repeated sessions of bilateral tDCS targeting the AC on chronic tinnitus. A double-blinded randomized placebo-controlled trial was conducted on patients (n = 48) with chronic intractable tinnitus (>2 years duration). Participants were randomly allocated to two groups: one receiving tDCS (n = 26), with the anode/cathode placed over the left/right AC, and the other receiving a placebo treatment (n = 22). A 20 min daily session of 2 mA current was administered for five consecutive days per week over two consecutive weeks, employing 35 cm2 electrodes. Tinnitus handicap inventory (THI) scores, tinnitus loudness, and tinnitus distress were measured using a visual analogue scale (VAS), and were assessed before intervention, immediately after, and at one-month follow-up. Anodal tDCS significantly reduced THI from 72.93 ± 10.11 score to 46.40 ± 15.36 after the last session and 49.68 ± 14.49 at one-month follow-up in 18 out of 25 participants (p < 0.001). The risk ratio (RR) of presenting an improvement of ≥20 points in the THI after the last session was 10.8 in patients treated with tDCS. Statistically significant reductions were observed in distress VAS and loudness VAS (p < 0.001). No statistically significant differences in the control group were observed. Variables such as age, gender, duration of tinnitus, laterality of tinnitus, baseline THI scores, and baseline distress and loudness VAS scores did not demonstrate significant correlations with treatment response. Repeated sessions of bilateral AC tDCS may potentially serve as a therapeutic modality for chronic tinnitus.
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Affiliation(s)
- Ali Yadollahpour
- Department of Psychology, University of Sheffield, Sheffield S1 2LT, UK;
- Bioelectromagnetic Clinic, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz 61357-15794, Iran
| | - Samaneh Rashidi
- Department of Psychology, University of Surrey, Guildford GU2 7XH, UK;
| | - Nader Saki
- Hearing and Speech Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz 61357-15794, Iran;
| | - Pramod Singh Kunwar
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, Mount Kenya University, Thika P.O. Box 342-01000, Kenya;
| | - Miguel Mayo-Yáñez
- Department of Otorhinolaryngology—Head and Neck Surgery, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006 A Coruña, Spain
- Department of Otorhinolaryngology—Head and Neck Surgery, Hospital San Rafael (HSR), 15006 A Coruña, Spain
- Otorhinolaryngology—Head and Neck Surgery Research Group, Institute of Biomedical Research of A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Universidade da Coruña (UDC), 15006 A Coruña, Spain
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5
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Adams W, Idnani S, Kim J. Transcranial Direct Current Stimulation for Orthopedic Pain: A Systematic Review with Meta-Analysis. Brain Sci 2024; 14:66. [PMID: 38248281 PMCID: PMC10813248 DOI: 10.3390/brainsci14010066] [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: 11/16/2023] [Revised: 12/16/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
(1) Background: Transcranial direct current stimulation (tDCS) appears to alleviate chronic pain via a brain-down mechanism. Although several review studies have examined the effects of tDCS on patients with chronic pain, no systematic review or meta-analysis has comprehensively analyzed the effects of tDCS on chronic orthopedic joint pain in one study. We aim to evaluate the effectiveness of tDCS for pain reduction in chronic orthopedic patients; (2) Methods: A comprehensive search of five electronic databases (Medline, Embase, Web of Science, CINAHL, and Cochrane) was performed. Only randomized controlled trials that compared tDCS with a control intervention were included. Eighteen studies met our inclusion criteria. We identified four categories of chronic orthopedic pain: knee (k = 8), lower back (k = 7), shoulder (k = 2), and orofacial pain (k = 1). Random effect models were utilized, and a sensitivity analysis was conducted in the presence of significant heterogeneity. Studies within each pain condition were further classified according to the number of treatment sessions: 1-5 sessions, 6-10 sessions, and >10 sessions.; (3) Results: Significant reductions in chronic orthopedic joint pain were observed following tDCS compared to controls for knee (g = 0.59, p = 0.005), lower back (g = 1.14, p = 0.005), and shoulder (g = 1.17, p = 0.020). Subgroup analyses showed pain reductions after 6-10 tDCS sessions for knee pain and after 1-5 and >10 sessions for lower back pain; (4) Conclusions: tDCS could be considered a potential stand-alone or supplemental therapy for chronic knee and lower back pain. The effectiveness of tDCS treatment varies depending on the number of treatment sessions. Our findings suggest the importance of implementing individualized treatment plans when considering tDCS for chronic pain conditions.
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Affiliation(s)
- William Adams
- Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL 33146, USA; (W.A.); (S.I.)
| | - Sherina Idnani
- Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL 33146, USA; (W.A.); (S.I.)
| | - Joosung Kim
- Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL 33146, USA; (W.A.); (S.I.)
- Department of Health and Human Performance, Texas State University, San Marcos, TX 78666, USA
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6
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Alipour A, Mohammadi R. Evaluation of the separate and combined effects of anodal tDCS over the M1 and F3 regions on pain relief in patients with type-2 diabetes suffering from neuropathic pain. Neurosci Lett 2024; 818:137554. [PMID: 37951301 DOI: 10.1016/j.neulet.2023.137554] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/17/2023] [Accepted: 11/06/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND Neuropathic pain (NP) is a common complication of chronic diabetes that negatively affects the routine functioning and sleep of patients. The present study aimed to investigate the separate and combined effects of anodal transcranial direct current stimulation (tDCS) over the primary motor cortex (M1) and left dorsolateral prefrontal cortex (F3) regions on pain relief in patients with type-2 diabetes suffering from NP. METHODS The statistical population of this double-blind randomized clinical trial consisted of all the members of the Bonab Diabetes Association in 2022 aged 45 to 65 years who were diagnosed with NP by a specialist. A total of 48 patients who met the inclusion criteria were selected as the sample through purposive sampling. The participants were then randomly assigned into 4 groups, each attending 12 sessions of a special intervention (three times a week). The Short Form-McGill Pain Questionnaire-2 (SF-MPQ-2) was used for data collection. Data were statistically analyzed using SPANOVA, analysis of covariance, and the Bonferroni test. RESULTS The results showed that tDCS had the potential to induce pain relief in patients with type-2 diabetes suffering from NP (F = 11.48, P < 0.001). The mean perceived pain intensity in the posttest was lower in the M1 stimulation group than in the F3 stimulation group. Nevertheless, there was no significant difference between the two groups in terms of perceived pain intensity in the one-month and two-month follow-up stages. CONCLUSIONS The tDCS approach (over both M1 and F3) showed promising effects for pain management in patients with type-2 diabetes suffering from NP and may be an effective add-on treatment. However, more trials with larger sample sizes are necessary to define clinically relevant effects.
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Affiliation(s)
- Ahmad Alipour
- Department of Psychology, Payame Noor University, Tehran, Iran
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7
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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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Estiasari R, Tiksnadi A, Tunjungsari D, Maharani K, Aninditha T, Sofyan HR, Savitri I, Pangeran D, Jeremia I, Widhani A, Ariane A. Effectiveness of transcranial direct current stimulation (tDCS) as adjunctive treatment for chronic headache in adults with clinically stable systemic lupus erythematosus (SHADE): a randomised double-blind multiarm sham controlled clinical trial. BMJ Open 2023; 13:e076713. [PMID: 38101851 PMCID: PMC10729133 DOI: 10.1136/bmjopen-2023-076713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Chronic headache is a 'silent' neuropsychiatric systemic lupus erythematosus symptom with heterogeneous prevalence, potentially reaching 54.4%. It may reduce quality of life by increasing the likelihood of depression and sleep disturbance. While pharmacotherapy remains the first-line treatment, the current management is still challenging and needs other non-invasive modalities. An effective, tolerable and disease-specific treatment modality including transcranial direct current stimulation (tDCS) is considered to reduce the frequency of chronic headaches, including in SLE. Until recently, there was no standard protocol for tDCS in treating headaches. METHODS AND ANALYSIS SHADE is a single-centre randomised double-blind multiarm sham-controlled trial for adults with clinically stable SLE, chronic headaches and without history of traumatic brain injury, brain infection, stroke or brain tumour. Random allocation is conducted to 88 subjects into 3 treatment groups (administration at primary motor, primary sensory and dorsolateral prefrontal cortex) and control group in 1:1:1:1 ratio. The primary endpoint is reduced number of headache days after adjunctive tDCS. The secondary endpoints are reduced headache intensity, increased quality of life, increased sleep quality, decreased depression and reduced analgesics use. The outcome is measured monthly until 3-month postintervention using headache diary, 36-Item Short Form Survey, Chronic Headache Quality of Life Questionnaire, Pittsburgh Sleep Quality Index and Mini International Neuropsychiatry Interview version 10 (MINI ICD 10). Intention-to-treat analysis will be performed to determine the best tDCS electrode placement. ETHICS AND DISSEMINATION Ethical approval had been obtained from the local Institutional Review Board of Faculty of Medicine Universitas Indonesia. Results will be published through scientific relevant peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05613582.
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Affiliation(s)
- Riwanti Estiasari
- Department of Neurology, Cipto Mangunkusumo National General Hospital, DKI Jakarta, Indonesia
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Amanda Tiksnadi
- Department of Neurology, Cipto Mangunkusumo National General Hospital, DKI Jakarta, Indonesia
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Dyah Tunjungsari
- Department of Neurology, Cipto Mangunkusumo National General Hospital, DKI Jakarta, Indonesia
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Kartika Maharani
- Department of Neurology, Cipto Mangunkusumo National General Hospital, DKI Jakarta, Indonesia
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Tiara Aninditha
- Department of Neurology, Cipto Mangunkusumo National General Hospital, DKI Jakarta, Indonesia
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Henry Riyanto Sofyan
- Department of Neurology, Cipto Mangunkusumo National General Hospital, DKI Jakarta, Indonesia
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Irma Savitri
- Department of Neurology, Cipto Mangunkusumo National General Hospital, DKI Jakarta, Indonesia
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - David Pangeran
- Department of Neurology, Cipto Mangunkusumo National General Hospital, DKI Jakarta, Indonesia
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Ivan Jeremia
- Department of Neurology, Cipto Mangunkusumo National General Hospital, DKI Jakarta, Indonesia
| | - Alvina Widhani
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Departement of Internal Medicine Allergy Immunology Division, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Anna Ariane
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Department of Internal Medicine Rheumatology Division, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
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9
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Rodrigues NO, Vidal Bravalhieri AA, de Moraes TP, Barros JA, Ansai JH, Christofoletti G. Efficacy of Transcranial Direct Current Stimulation (tDCS) on Cognition, Anxiety, and Mobility in Community-Dwelling Older Individuals: A Controlled Clinical Trial. Brain Sci 2023; 13:1614. [PMID: 38137062 PMCID: PMC10741841 DOI: 10.3390/brainsci13121614] [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: 10/24/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023] Open
Abstract
Transcranial direct current stimulation (tDCS) has gained popularity as a method of modulating cortical excitability in people with physical and mental disabilities. However, there is a lack of consensus on its effectiveness in older individuals. This study aimed to assess the efficacy of a 2-month tDCS program for improving physical and mental performance in community-dwelling older individuals. In this single-blinded, controlled clinical trial, forty-two participants were allocated to one of three groups: (1) the tDCS group, which received, twice a week, 20 min sessions of 2 mA electric current through electrodes placed on the dorsolateral prefrontal cortex; (2) the tDCS-placebo group, which underwent the same electrode placement as the tDCS group but without actual electric stimulation; and (3) the cognitive-control group, which completed crossword puzzles. Main outcome measures were cognition, mobility, and anxiety. Multivariate analyses of variance were employed. Significance was set at 5% (p < 0.05). Regarding the results, no significant benefits were observed in the tDCS group compared with the tDCS-placebo or cognitive-control groups for cognition (p = 0.557), mobility (p = 0.871), or anxiety (p = 0.356). Cognition exhibited positive oscillations during the assessments (main effect of time: p = 0.001). However, given that all groups showed similar variations in cognitive scores (main effect of group: p = 0.101; group × time effect: p = 0.557), it is more likely that the improvement reflects the learning response of the participants to the cognitive tests rather than the effect of tDCS. In conclusion, a 2-month tDCS program with two sessions per week appears to be ineffective in improving physical and mental performance in community-dwelling older individuals. Further studies are necessary to establish whether or not tDCS is effective in healthy older individuals.
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Affiliation(s)
- Nathalia Oliveira Rodrigues
- Institute of Health, Faculty of Medicine, Federal University of Mato Grosso do Sul (UFMS), Campo Grande 79060-900, Brazil; (N.O.R.); (A.A.V.B.); (T.P.d.M.)
| | - Anna Alice Vidal Bravalhieri
- Institute of Health, Faculty of Medicine, Federal University of Mato Grosso do Sul (UFMS), Campo Grande 79060-900, Brazil; (N.O.R.); (A.A.V.B.); (T.P.d.M.)
| | - Tatiane Pereira de Moraes
- Institute of Health, Faculty of Medicine, Federal University of Mato Grosso do Sul (UFMS), Campo Grande 79060-900, Brazil; (N.O.R.); (A.A.V.B.); (T.P.d.M.)
| | - Jorge Aparecido Barros
- Department of Physical Therapy, Dom Bosco Catholic University (UCDB), Campo Grande 79117-900, Brazil;
| | - Juliana Hotta Ansai
- Department of Gerontology, Federal University of São Carlos (UFSCAR), São Carlos 13565-905, Brazil;
| | - Gustavo Christofoletti
- Institute of Health, Faculty of Medicine, Federal University of Mato Grosso do Sul (UFMS), Campo Grande 79060-900, Brazil; (N.O.R.); (A.A.V.B.); (T.P.d.M.)
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Moshfeghinia R, Shekouh D, Mostafavi S, Hosseinzadeh M, Bahadori AR, Abdollahifard S, Razmkon A. The effects of transcranial direct-current stimulation (tDCS) on pain intensity of patients with fibromyalgia: a systematic review and meta-analysis. BMC Neurol 2023; 23:395. [PMID: 37919664 PMCID: PMC10621179 DOI: 10.1186/s12883-023-03445-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/22/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION Fibromyalgia (FM) is a chronic pain condition that affects millions of people worldwide. Transcranial Direct Current Stimulation (tDCS) is a non-invasive brain stimulation technique that has shown promise as a potential treatment for FM by modulating pain perception and reducing symptoms, such as fatigue and depression. We aimed to systematically review studies that assess the effect of tDCS on pain reduction in FM patients. METHODS Seven electronic databases (PubMed, Scopus, Embase, PsycINFO, Web of Science, Cochrane, and CINAHL Complete) were searched for records in English. Studies that measured the effect of tDCS on pain intensity in FM patients were included. The Cochrane Collaboration's tool was used to assess the quality of the included studies. A random-effect model was preferred, and statistical analysis was performed by Stata software version 17. RESULTS Twenty studies were included for qualitative, and eleven for quantitative analysis. Out of 664 patients included in the study, 443 were in the stimulation group. The left M1 area was the most common stimulation target (n = 12), and 2 mA was the most common stimulation amplitude (n = 19). The analysis showed that active tDCS significantly reduced pain intensity in FM patients in comparison to the sham group (SMD= -1.55; 95% CI -2.10, -0.99); also, no publication bias was noted. CONCLUSION Our systematic review highlights the potential effect of tDCS on the reduction of pain intensity in FM patients. Additionally, this current evidence could suggest that tDCS applied at an intensity of 2mA to the left M1 is the most effective strategy.
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Affiliation(s)
- Reza Moshfeghinia
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Research Center for Neuromodulation and Pain, 4th floor, Boghrat building, Zand Street, Shiraz, Iran
| | - Dorsa Shekouh
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Research Center for Neuromodulation and Pain, 4th floor, Boghrat building, Zand Street, Shiraz, Iran
| | - Sara Mostafavi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Research Center for Neuromodulation and Pain, 4th floor, Boghrat building, Zand Street, Shiraz, Iran
| | - Mehrnaz Hosseinzadeh
- Fasa Neuroscience Circle (FNC), Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
| | - Amir Reza Bahadori
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Research Center for Neuromodulation and Pain, 4th floor, Boghrat building, Zand Street, Shiraz, Iran
| | - Saeed Abdollahifard
- Research Center for Neuromodulation and Pain, 4th floor, Boghrat building, Zand Street, Shiraz, Iran
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Razmkon
- Research Center for Neuromodulation and Pain, 4th floor, Boghrat building, Zand Street, Shiraz, Iran.
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Shlobin NA, Wu C. Current Neurostimulation Therapies for Chronic Pain Conditions. Curr Pain Headache Rep 2023; 27:719-728. [PMID: 37728863 DOI: 10.1007/s11916-023-01168-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE OF REVIEW Neurostimulation treatment options have become more commonly used for chronic pain conditions refractory to these options. In this review, we characterize current neurostimulation therapies for chronic pain conditions and provide an analysis of their effectiveness and clinical adoption. This manuscript will inform clinicians of treatment options for chronic pain. RECENT FINDINGS Non-invasive neurostimulation includes transcranial direct current stimulation and repetitive transcranial magnetic stimulation, while more invasive options include spinal cord stimulation (SCS), peripheral nerve stimulation (PNS), dorsal root ganglion stimulation, motor cortex stimulation, and deep brain stimulation. Developments in transcranial direct current stimulation, repetitive transcranial magnetic stimulation, spinal cord stimulation, and peripheral nerve stimulation render these modalities most promising for the alleviating chronic pain. Neurostimulation for chronic pain involves non-invasive and invasive modalities with varying efficacy. Well-designed randomized controlled trials are required to delineate the outcomes of neurostimulatory modalities more precisely.
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Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Chengyuan Wu
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, 909 Walnut Street, Floor 2, Philadelphia, PA, 19107, USA.
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Chen YL, Chen Q, Li LW, Hua C, Zhang XY, Zheng H. Non-invasive brain stimulation treatments for migraine prophylaxis: a network meta-analysis of randomized controlled trials. Acta Neurol Belg 2023:10.1007/s13760-023-02277-z. [PMID: 37184609 DOI: 10.1007/s13760-023-02277-z] [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: 08/24/2022] [Accepted: 05/05/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Migraine is a major public health problem owing to its long disease duration and disease relapse. Non-invasive brain stimulation treatments were reported effective for the management of migraine, but the comparative effectiveness of three main NIBSs, rTMS, nVNS, and tDCS, has not been studied. We aimed to explore the relative efficacy of rTMS, tDCS, and nVNS in migraine prophylaxis by using network meta-analysis (NMA). METHODS We searched OVID Medline, Embase, Cochrane Controlled Register of Trials, and Web of Science from inception to 1 January 2022. Randomized controlled trials that reported the efficacy of rTMS, tDCS or nVNS in the prophylactic treatment of migraine were included. The primary outcome was monthly migraine frequency, and secondary outcomes were headache intensity and the impact of headaches on daily life. The relative effects of the treatments in contrast to the others were measured by using standard mean difference (SMD). RESULTS We included 31 trials with 1659 participants. Fourteen trials were rated as low risk of bias. The results showed that tDCS (SMD - 1.58; 95%CI, - 2.38 to - 0.79; P-score = 0.92) had the largest effect on migraine frequency when compared with sham interventions in reducing monthly migraine frequency, and tDCS had a larger effect than rTMS (SMD - 0.62; 95%CI, - 1.81 to 0.57) and nVNS (SMD - 1.39; 95%CI, - 3.27 to 0.49). tDCS had also the largest effect in reducing pain intensity when compared with sham intervention (SMD - 1.49; 95%CI, - 2.46 to - 0.52) and rTMS (SMD - 0.48; 95%CI, - 2.06 to 1.09). CONCLUSIONS For the prophylactic treatment of migraine, tDCS was relatively more effective than rTMS and nVNS. Head-to-head comparison trials are needed to confirm the findings.
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Affiliation(s)
- Yi-Lin Chen
- The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Avenue, Wenjiang District, Chengdu, 610000, China
| | - Qian Chen
- The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Avenue, Wenjiang District, Chengdu, 610000, China
| | - Li-Wen Li
- The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Avenue, Wenjiang District, Chengdu, 610000, China
| | - Can Hua
- The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Avenue, Wenjiang District, Chengdu, 610000, China
| | - Xin-Yue Zhang
- The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Avenue, Wenjiang District, Chengdu, 610000, China
| | - Hui Zheng
- The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Avenue, Wenjiang District, Chengdu, 610000, China.
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