Analgesic Effect of Transcranial Direct Current Stimulation on Central Post-Stroke Pain

Abstract

Pain that occurs after a stroke lowers the quality of life. Such post-stroke pain is caused in part by the brain lesion itself, called central post-stroke pain. We investigated the analgesic effects of transcranial direct current stimulation (tDCS) in stroke patients through quantitative sensory testing. Fourteen participants with central post-stroke pain (7 female and 7 male subjects) were recruited and were allocated to either tDCS (n = 7) or sham-tDCS (n = 7) group. Their ages ranged from 45 to 55 years. tDCS was administered for 20 min at a 2-mA current intensity, with anodal stimulations were performed at primary motor cortex. The sham-tDCS group was stimulated 30-second current carrying time. Both group interventions were given for 3 days per week, for a period of 3 weeks. Subjective pain was measured using the visual analogue scale (VAS) of 0 to 10. Sensations of cold and warmth, and pain from cold and heat were quantified to examine analgesic effects. The sham-tDCS group showed no statistically significant differences in time. In contrast, tDCS group showed decreased VAS scores and skin temperature (p < 0.05). The threshold temperatures for the sense of cold and pain from cold increased (p < 0.05), and those for the sense of warmth and pain from heat decreased (p < 0.05). Our findings indicate that tDCS improved sensory identification and exerted analgesic effects in the stroke patients with central post-stroke pain.

Motor Cortex Neurostimulation Technologies for Chronic Post-stroke Pain: Implications of Tissue Damage on Stimulation Currents

“…Stimulation of primary motor cortex (M1) appears to be the most effective cortical target (Nguyen et al, 1999; Kumar and Soni, 2009; Hirabayashi et al, 2011; DosSantos et al, 2012; Fregni et al, 2014; Brietzke et al, 2015; Cioato et al, 2015; Morishita et al, 2015; Oh and Seo, 2015). Analgesia is believed to be achieved through the stimulation of M1-thalmic relays to reduce hyperactivity in thalamic linked pain networks (Tsubokawa et al, 1993; Mertens et al, 1999; Khedr et al, 2005; Garcia-Larrea and Peyron, 2007; Peyron et al, 2007; Lima and Fregni, 2008; Nguyen et al, 2008; Fontaine et al, 2009; Lefaucheur et al, 2009; Ohn et al, 2012; Bae et al, 2014; Hasan et al, 2014; Lefaucheur, 2016). …”

“…While EBS, TMS, and tDCS have shown some clinical success in treating CPSP, high variability across studies has impeded their widespread acceptance (Mertens et al, 1999; Lefaucheur et al, 2004, 2009; Lima and Fregni, 2008; Nguyen et al, 2008; Fontaine et al, 2009; DosSantos et al, 2012; Bae et al, 2014; Lefaucheur, 2016). Upward of 30% of EBS patients do not respond to stimulation (Tsubokawa et al, 1993; Katayama et al, 1998; Mertens et al, 1999; Nguyen et al, 1999).…”

Efficacy of Transcranial Direct-Current Stimulation in Women With Provoked Vestibulodynia

“…Previous authors clearly showed the analgesic effect of tDCS in fibromyalgia, 23 spinal cord injury, 18,21 and post-stroke pain 53,57 using RCTs. It is possible that tDCS has greater effect for unprovoked types of pain, as observed by Cecilio et al, 13 than for provoked pain conditions like PVD.…”

Transcranial direct current stimulation (tDCS) and trigeminal pain: A preclinical study

“…Transcranial direct current stimulation (tDCS) is a non‐invasive method of cerebral stimulation that may represent a promising tool for modulating trigeminal nociceptive processes and decreasing the pain response (Hagenacker et al, ). It has been used in the treatment of several pain conditions in patients, such as central poststroke pain (Bae, Kim, & Kim, ); it has also been tested in animal pain models, including mechanical allodynia in chronically stressed rats (Spezia Adachi et al, ) and neuropathic (Cioato et al, ) or inflammatory pain (Laste et al, ).…”