The effects of transcranial direct current stimulation in patients with neuropathic pain from spinal cord injury

Ngernyam, Niran; Jensen, Mark P.; Arayawichanon, Preeda; Auvichayapat, Narong; Tiamkao, Somsak; Janjarasjitt, Suparerk; Punjaruk, Wiyada; Amatachaya, Anuwat; Aree-uea, Benchaporn; Auvichayapat, Paradee

doi:10.1016/j.clinph.2014.05.034

Cited by 97 publications

(77 citation statements)

References 34 publications

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“…In a previous study, our group has tested the effects of tDCS in SCI patients suffering from neuropathic pain, showing that 5 sessions of M1 tDCS significantly reduced level of pain after the end of the stimulation sessions but not when reassessed at 2-week follow-up [7]. Other studies, investigating the neural correlates of tDCS in SCI, or the combination of tDCS with adjuvant therapy, have found similar results on pain intensity reduction following the stimulation of M1 [17][18][19][20].…”

Section: Introductionmentioning

confidence: 77%

“…This observation highlights the long-term effects of tDCS in maintaining low level of pain as compared to the sham intervention. As abovementioned, several studies have highlighted the need for repeating the number of tDCS sessions (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) to induce long-lasting and clinically relevant effects. In the present study, even with a limited sample size, we demonstrated that adding a second phase of 10 stimulations sessions can help maintaining the benefits induced by tDCS.…”

Section: Long-lasting Effects Of Tdcsmentioning

confidence: 99%

See 1 more Smart Citation

Delayed pain decrease following M1 tDCS in spinal cord injury: A randomized controlled clinical trial

Thibaut

Carvalho

Morse

et al. 2017

Neuroscience Letters

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Section: Introductionmentioning

confidence: 77%

Section: Long-lasting Effects Of Tdcsmentioning

confidence: 99%

Delayed pain decrease following M1 tDCS in spinal cord injury: A randomized controlled clinical trial

Thibaut

Carvalho

Morse

et al. 2017

Neuroscience Letters

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“…Three studies found a significant reduction in pain intensity with tDCS compared with sham control. [31][32][33] One of these studies found a significant improvement in continuous pain on the last day of treatment, and paroxysmal pain at follow-up, but no significant reduction in overall pain intensity. 33 A fourth study did not find a significant difference between tDCS and sham control.…”

Section: Third-line Therapy Recommendation 26mentioning

confidence: 99%

The CanPain SCI Clinical Practice Guidelines for Rehabilitation Management of Neuropathic Pain after Spinal Cord: Recommendations for treatment

et al. 2016

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Study design: Clinical practice guidelines. Objectives: To develop the first Canadian clinical practice guidelines for treatment of neuropathic pain in people with spinal cord injury (SCI). Setting: The guidelines are relevant for inpatient and outpatient SCI rehabilitation settings in Canada. Methods: The CanPainSCI Working Group reviewed the evidence for different treatment options and achieved consensus. The Working Group then developed clinical considerations for each recommendation. Recommendations for research are also included. Results: Twelve recommendations were developed for the management of neuropathic pain after SCI. The recommendations address both pharmacologic and nonpharmacologic treatment modalities. Conclusions: An expert Working Group developed recommendations for the treatment of neuropathic pain after SCI that should be used to inform practice.

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“…A constant current of 2 mA for 20 min was delivered to the tDCS group while the sham group received stimulation for 30 s after which it was turned off. Ngernyam et al 20 randomized individuals into active or sham tDCS groups with a 1-week washout period before individuals were crossed over to the alternative protocol. Individuals received a single session of 2 mA active or sham treatment for 20 min.…”

Section: Methodsmentioning

confidence: 99%

“…These included two double-blinded randomized controlled trials (RCTs), 12,19 two doubleblinded crossover RCTs, 20,21 and one prospective controlled trial. 22 The methodological quality was excellent for the four RCTs, 12,[19][20][21] whereas the prospective controlled trial 22 was fair in quality (Table 1). …”

Section: Study Selection and Qualitymentioning

confidence: 99%

Effectiveness of transcranial direct current stimulation for the management of neuropathic pain after spinal cord injury: a meta-analysis

et al. 2015

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Objectives: To conduct a systematic review and meta-analysis to examine the effect of transcranial direct current stimulation (tDCS) on reducing neuropathic pain intensity in individuals with spinal cord injury (SCI). Methods: Medline, CINAHL, EMBASE and PsycINFO databases were searched for all relevant articles published from 1980 to November 2014. Trials were included if (i) tDCS intervention group and a placebo control group were present; (ii) at least 50% of participants in the study had an SCI and there were at least three participants; (iii) participants were aged 18 years or older; and (iv) persistent pain for at least 3 months. Studies were excluded if: (i) the tDCS intervention group was compared with an active treatment group; (ii) there was insufficient reporting detail to enable pooling of data; and (iii) it was a nonclinical trial (that is, reviews, epidemiology, basic sciences). A standardized mean difference (SMD) ± s.e. and 95% confidence interval (CI) was calculated for each outcome of interest and the results were pooled using a fixed or random effects model, as appropriate. Effect sizes were interpreted as: small 40.2, moderate 40.5, large 40.8. Results: Five studies met inclusion criteria of which four were randomized controlled trials and one was a prospective controlled trial. The pooled analysis found a significant effect of tDCS on reducing neuropathic pain after SCI post treatment (SMD = 0.510 ± 0.202; 95% CI, 0.114-0.906; Po0.012); however, this effect was not maintained at follow-up (SMD = 0.353 ± 0.272; 95% CI, − 0.179 to 0.886; Po0.194). A reduction of 1.33 units on a 10-item scale was observed post treatment. No significant adverse events were reported. Conclusion: Meta-analytic results indicate a moderate effect of tDCS in reducing neuropathic pain among individuals with SCI; however, the effect was not maintained at follow-up. A mean pooled decrease of 1.33 units on a 10-item scale was found post treatment. Several factors were implicated in the effectiveness of tDCS in reducing pain. Due to the limited number of studies and lack of follow-up, more evidence is required before treatment recommendations can be made. Spinal Cord (2015) 53, 780-785; doi:10.1038/sc.2015.118; published online 21 July 2015 INTRODUCTIONChronic neuropathic pain (NP) can occur following lesions in the somatosensory nervous system 1 and incidence rates range from~50 2,3 to 75-81%. 4,5 Several treatments have been proposed and used to manage NP, particularly pharmacological methods (for example, antidepressants, anticonvulsants, opioids). 6,7 Despite multiple pharmacological options for pain, the majority of individuals fail to find relief; the refractory nature of NP is what makes it such a difficult condition to treat and to endure. Studies have shown that refractory NP is common post SCI 8 and that few (4-6%) obtain relief over the long-term. 9 This situation has created interest in alternative neuromodulary stimulation approaches such as cranial electrotherapy stimulation, transcutaneous electrical nerve ...

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The effects of transcranial direct current stimulation in patients with neuropathic pain from spinal cord injury

Cited by 97 publications

References 34 publications

Delayed pain decrease following M1 tDCS in spinal cord injury: A randomized controlled clinical trial

Delayed pain decrease following M1 tDCS in spinal cord injury: A randomized controlled clinical trial

The CanPain SCI Clinical Practice Guidelines for Rehabilitation Management of Neuropathic Pain after Spinal Cord: Recommendations for treatment

Effectiveness of transcranial direct current stimulation for the management of neuropathic pain after spinal cord injury: a meta-analysis

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