Non-invasive brain stimulation techniques for chronic pain

O’Connell, Neil E; Wand, Benedict M; Marston, Louise; Spencer, Sally; DeSouza, Lorraine H

doi:10.1002/14651858.cd008208.pub2

Cited by 113 publications

(151 citation statements)

References 68 publications

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“…rTMS of M1 has proven efficacious in the treatment of chronic pain [16,19]. Further, high frequency rTMS of M1 in healthy populations show this technique can modulate experimental pain thresholds [16,26].…”

Section: Rtmsmentioning

confidence: 99%

“…In contrast, high frequency rTMS (>5 Hz) has been shown to increase neuronal excitability and consequently lead to a parallel increase in pain thresholds [26]. According to a Cochrane review, 2010, [19] low frequency rTMS alone, was not worthy of further research as a possible intervention for chronic pain. However, recent studies have demonstrated that preconditioning via tDCS reverses the expected effects of subsequent administration of low frequency rTMS [8], on the basis of standardizing the primary state of activity of the targeted area of the cortex.…”

Section: Tdcs Priming To Enhance 1 Hz Rtmsmentioning

confidence: 99%

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Transcranial direct current stimulation (tDCS) priming of 1Hz repetitive transcranial magnetic stimulation (rTMS) modulates experimental pain thresholds

Moloney

Witney

2013

Neuroscience Letters

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Section: Rtmsmentioning

confidence: 99%

Section: Tdcs Priming To Enhance 1 Hz Rtmsmentioning

confidence: 99%

Transcranial direct current stimulation (tDCS) priming of 1Hz repetitive transcranial magnetic stimulation (rTMS) modulates experimental pain thresholds

Moloney

Witney

2013

Neuroscience Letters

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“…Regarding the analgesic effects, significant results have been reported in various persistent pain syndromes, such as fibromyalgia [10], central pain in traumatic spinal cord injury [11], and chronic migraine [12]. However, neither the analgesic outcomes with tDCS are consistent across studies [13]–[15], nor its endogenous neuromechanisms well understood.…”

Section: Introductionmentioning

confidence: 99%

Building up Analgesia in Humans via the Endogenous μ-Opioid System by Combining Placebo and Active tDCS: A Preliminary Report

et al. 2014

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Transcranial Direct Current Stimulation (tDCS) is a method of non-invasive brain stimulation that has been frequently used in experimental and clinical pain studies. However, the molecular mechanisms underlying tDCS-mediated pain control, and most important its placebo component, are not completely established. In this pilot study, we investigated in vivo the involvement of the endogenous μ-opioid system in the global tDCS-analgesia experience. Nine healthy volunteers went through positron emission tomography (PET) scans with [11C]carfentanil, a selective μ-opioid receptor (MOR) radiotracer, to measure the central MOR activity during tDCS in vivo (non-displaceable binding potential, BPND) - one of the main analgesic mechanisms in the brain. Placebo and real anodal primary motor cortex (M1/2mA) tDCS were delivered sequentially for 20 minutes each during the PET scan. The initial placebo tDCS phase induced a decrease in MOR BPND in the periaqueductal gray matter (PAG), precuneus, and thalamus, indicating activation of endogenous μ-opioid neurotransmission, even before the active tDCS. The subsequent real tDCS also induced MOR activation in the PAG and precuneus, which were positively correlated to the changes observed with placebo tDCS. Nonetheless, real tDCS had an additional MOR activation in the left prefrontal cortex. Although significant changes in the MOR BPND occurred with both placebo and real tDCS, significant analgesic effects, measured by improvements in the heat and cold pain thresholds, were only observed after real tDCS, not the placebo tDCS. This study gives preliminary evidence that the analgesic effects reported with M1-tDCS, can be in part related to the recruitment of the same endogenous MOR mechanisms induced by placebo, and that such effects can be purposely optimized by real tDCS.

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“…Another limitation is the variation in applied stimulation parameters such as frequency (ranged from 5 Hz to 20 Hz), intensity of RMT (ranged from 80% to 115%), and total number of pulses (ranged between 120 and 2,500). A 2010 Cochrane Systematic Review concluded that higher stimulation frequencies (>5 Hz), greater numbers of stimuli (>500), and multiple sessions (>1) yielded better results 45. The contribution of many TMS factors, including coil orientation, duration of each pulse train, inter-train interval, and number of trains, is not yet understood.…”

Section: Review Of the Studies Of Rtms Of The Motor Cortex For Chronimentioning

confidence: 99%

“…These are considerable in both pain trials and device trials. However, given that TMS evokes both visual, auditory, and tactile sensations, sham procedures are difficult to design, and there is no consensus regarding the best design of a true double-blinded, sham-controlled study, since researchers and often subjects can usually distinguish between real and sham devices 45. Some methods of sham TMS offer visual verisimilitude, e.g.…”

Section: Review Of the Studies Of Rtms Of The Motor Cortex For Chronimentioning

confidence: 99%

Non-invasive Transcranial Magnetic Stimulation (TMS) of the Motor Cortex for Neuropathic Pain—At the Tipping Point?

Treister¹,

Lang²,

Klein³

et al. 2013

Rambam Maimonides Med J

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The term “neuropathic pain” (NP) refers to chronic pain caused by illnesses or injuries that damage peripheral or central pain-sensing neural pathways to cause them to fire inappropriately and signal pain without cause. Neuropathic pain is common, complicating diabetes, shingles, HIV, and cancer. Medications are often ineffective or cause various adverse effects, so better approaches are needed. Half a century ago, electrical stimulation of specific brain regions (neuromodulation) was demonstrated to relieve refractory NP without distant effects, but the need for surgical electrode implantation limited use of deep brain stimulation. Next, electrodes applied to the dura outside the brain’s surface to stimulate the motor cortex were shown to relieve NP less invasively. Now, electromagnetic induction permits cortical neurons to be stimulated entirely non-invasively using transcranial magnetic stimulation (TMS). Repeated sessions of many TMS pulses (rTMS) can trigger neuronal plasticity to produce long-lasting therapeutic benefit. Repeated TMS already has US and European regulatory approval for treating refractory depression, and multiple small studies report efficacy for neuropathic pain. Recent improvements include “frameless stereotactic” neuronavigation systems, in which patients’ head MRIs allow TMS to be applied to precise underlying cortical targets, minimizing variability between sessions and patients, which may enhance efficacy. Transcranial magnetic stimulation appears poised for the larger trials necessary for regulatory approval of a NP indication. Since few clinicians are familiar with TMS, we review its theoretical basis and historical development, summarize the neuropathic pain trial results, and identify issues to resolve before large-scale clinical trials.

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Non-invasive brain stimulation techniques for chronic pain

Cited by 113 publications

References 68 publications

Transcranial direct current stimulation (tDCS) priming of 1Hz repetitive transcranial magnetic stimulation (rTMS) modulates experimental pain thresholds

Transcranial direct current stimulation (tDCS) priming of 1Hz repetitive transcranial magnetic stimulation (rTMS) modulates experimental pain thresholds

Building up Analgesia in Humans via the Endogenous μ-Opioid System by Combining Placebo and Active tDCS: A Preliminary Report

Non-invasive Transcranial Magnetic Stimulation (TMS) of the Motor Cortex for Neuropathic Pain—At the Tipping Point?

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