Transcutaneous spinal DC stimulation reduces pain sensitivity in humans

Meyer-Frießem, Christine H; Haag, Lauren M.; Schmidt‐Wilcke, Tobias; Magerl, Walter; Pogatzki-Zahn, Esther; Tegenthoff, Martin; Zahn, Peter

doi:10.1016/j.neulet.2015.01.029

Cited by 24 publications

(26 citation statements)

References 38 publications

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“…Recent neurophysiological evidence has shown suppressive effects of anodal tsDCS on nociceptive signal processing. In addition to the modulating effects at an electrophysiological level, anodal tsDCS significantly decreased subjective pain reports to painful mechanical stimuli in humans and induced early and long-lasting depression of the transitory facilitation of wide dynamic range neuronal activity [24,25]. Nonetheless, we failed to detect significant differences between anodal and sham tsDCS.…”

Section: Discussioncontrasting

confidence: 58%

“…This suggests that anodal spinal tsDCS may reduce painful reflexes and may be associated with analgesic effects. Furthermore, anodal tsDCS can suppress the pain sensitivity associated with nociceptive mechanical stimuli [24], and anodal tsDCS can modulate temporal summation of pain based on depression of the transitory facilitation of the activity of wide dynamic range neurons [25]. In brief, tsDCS modulates neuronal activity in lemniscal, spinothalamic, and segmental spinal circuits, suggesting glutamatergic, GABAergic, and glycinergic system involvement, and eventual effects on spinal plasticity [26,27].…”

Section: Introductionmentioning

confidence: 99%

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Pilot study of feasibility and effect of anodal transcutaneous spinal direct current stimulation on chronic neuropathic pain after spinal cord injury

2019

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Study design A single-blind crossover study. Objectives This study aimed to evaluate neuropathic pain in persons with spinal cord injury (SCI) after the application of transcutaneous spinal direct current stimulation (tsDCS). Setting Outpatient Clinic of the Rehabilitation Department, Seoul National University Hospital. Methods The effect of single sessions of both anodal and sham tsDCS (2 mA, 20 min) on chronic neuropathic pain in ten volunteers with complete motor cervical SCI was assessed. The active electrode was placed over the spinal process of the tenth thoracic vertebra and the reference electrode, at the top of the head. Pre-to post-tsDCS intervention changes in pain intensity (numeric rating scale, NRS), patient global assessment, and present pain intensity (PPI) were assessed before and after the tsDCS session (immediately post stimulation, and at 1 and 2 h post stimulation). Results All participants underwent the stimulation procedure without dropout. Our results showed no significant pre-to post-treatment difference in pain intensity between the active and sham tsDCS groups. Only in the sham tsDCS stimulation, NRS and PPI scores were reduced after the stimulation session. Furthermore, in the mixed effect model analysis, the response in the second period appeared to be more favorable. Conclusion The results suggest that a single session of anodal tsDCS with the montage used in this study is feasible but does not have a significant analgesic effect in individuals with chronic cervical SCI. Sponsorship The study was funded by Seoul National University Hospital (No. 0420160470) and Korea Workers' Compensation & Welfare Service.

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Section: Discussioncontrasting

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Pilot study of feasibility and effect of anodal transcutaneous spinal direct current stimulation on chronic neuropathic pain after spinal cord injury

2019

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“…No reduction was observed for the responses elicited by nociceptive stimulation of the face. The finding that tsDCS may modulate the transmission of nociceptive inputs conveyed by the spinothalamic pathway is also supported by the results of Meyer-Friessem et al (2015) showing that low-thoracic anodal tsDCS reduced the percept elicited by nociceptive mechanical pinprick stimuli delivered to the thigh. Alongside these reports suggesting an effect of tsDCS on the spinal transmission of nociceptive inputs, one study suggested that anodal tsDCS may also modulate the responses to non-nociceptive somatosensory stimuli conveyed by the dorsal column – medial lemniscus pathway (Cogiamanian et al , 2008).…”

Section: Introductionmentioning

confidence: 56%

“…Finally, studies have shown an effect of anodal low-thoracic tsDCS on nociceptive (Cogiamanian et al , 2011; Perrotta et al , 2016) and non-nociceptive (Winkler et al , 2010; Lim & Shin, 2011; Lamy et al , 2012; Donges et al , 2017) spinal reflexes. Because the first synaptic relay of non-nociceptive somatosensory inputs conveyed by the dorsal column – medial lemniscus pathway is at the level of the medulla oblonogata, the finding that low-thoracic anodal tsDCS may reduce both supraspinal responses to lower-limb nociceptive inputs conveyed by the spinothalamic tract (Truini et al , 2011; Meyer-Friessem et al , 2015) and supraspinal responses to lower-limb non-nociceptive inputs conveyed by the dorsal columns (Cogiamanian et al , 2008) has led researchers to conclude that the neuromodulatory effects of tsDCS result from a blocking of axonal conduction of action potentials, rather than an inhibitory effect on synaptic efficacy (Cogiamanian et al , 2008; Truini et al , 2011). Such an axonal conduction blockade would be analogous to the “anodal blockade” that can be induced by electrical stimulation of a peripheral nerve (Bhadra & Kilgore, 2004) and would affect indifferently the axons forming both the ascending spino-thalamic tracts and the dorsal column pathways.…”

Section: Introductionmentioning

confidence: 99%

Anodal Transcutaneous Spinal Direct Current Stimulation (tsDCS) Selectively Inhibits the Synaptic Efficacy of Nociceptive Transmission at Spinal Cord Level

2018

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Recently studies have aimed at developing transcutaneous spinal direct current stimulation (tsDCS) as a non-invasive technique to modulate spinal function in humans. Independent studies evaluating its after-effects on nociceptive or non-nociceptive somatosensory responses have reported comparable effects suggesting that tsDCS impairs axonal conduction of both the spino-thalamic and the medial lemniscus tracts. The present study aimed to better understand how tsDCS affects, in humans, the spinal transmission of nociceptive and non-nociceptive somatosensory inputs. We compared the after-effects of anodal low-thoracic, anodal cervical and sham tsDCS on the perception and brain responses elicited by laser stimuli selectively activating Aδ-thermonociceptors of the spinothalamic system and vibrotactile stimuli selectively activating low threshold Aβ-mechanoreceptors of the lemniscal system, delivered to the hands and feet. Low-thoracic tsDCS selectively and significantly affected the LEP-N2 wave elicited by nociceptive stimulation of the lower limbs, without affecting the LEP-N2 wave elicited by nociceptive stimulation of the upper limbs, and without affecting the SEP-N2 wave elicited by vibrotactile stimulation of either limb. This selective and segmental effect indicates that the neuromodulatory after-effects of tsDCS cannot be explained by anodal blockade of axonal conduction and, instead, are most probably due to a segmental effect on the synaptic efficacy of the local processing and/or transmission of nociceptive inputs in the dorsal horn.

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“…In cat, rat and mouse models, tsDCS can modulate activity in sensory and motor pathways, and such changes have been observed both during and after tsDCS (Aguilar et al 2011;Ahmed, 2011Ahmed, , 2013aAhmed, ,b, 2014aAhmed & Wieraszko, 2012;Bolzoni & Jankowska, 2015;Song et al 2015). In humans, most studies have focused on the delivery of tsDCS at a thoracic level (T10-T12), observing modifications to ascending sensory pathways (Cogiamanian et al 2008;Truini et al 2011;Meyer-Frießem et al 2015) and spinal reflex pathways (Winkler et al 2010;Cogiamanian et al 2011;Lamy et al 2012;Hubli et al 2013;Lamy & Boakye, 2013;Heide et al 2014;Perrotta et al 2016). These studies in humans report modifications that occur after tsDCS offset; however, soleus H-reflex modulation was also reported to occur during tsDCS (Lamy et al 2012;Lamy & Boakye, 2013).…”

Section: Introductionmentioning

confidence: 99%

Concurrent electrical cervicomedullary stimulation and cervical transcutaneous spinal direct current stimulation result in a stimulus interaction

Dongés

Bai

Taylor

2017

Experimental Physiology

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What is the central question of this study? We previously showed that the motor pathway is not modified after cervical transcutaneous spinal direct current stimulation (tsDCS) applied using anterior-posterior electrodes. Here, we examine the motor pathway during stimulation. What is the main finding and its importance? We show that electrically elicited muscle responses to cervicomedullary stimulation are modified during tsDCS, whereas magnetically elicited responses are not. Modelling reveals electrical field modifications during concurrent tsDCS and electrical cervicomedullary stimulation. Changes in muscle response probably result from electrical field modifications rather than physiological changes. Care should be taken when applying electrical stimuli simultaneously. Transcutaneous spinal direct current stimulation (tsDCS) can modulate neuronal excitability within the human spinal cord; however, few studies have used tsDCS at a cervical level. This study aimed to characterize cervical tsDCS further by observing its acute effects on motor responses to transcranial magnetic stimulation and cervicomedullary stimulation. In both studies 1 and 2, participants (study 1, n = 8, four female; and study 2, n = 8, three female) received two periods of 10 min, 3 mA cervical tsDCS on the same day through electrodes placed in an anterior-posterior configuration over the neck; one period with the cathode posterior (c-tsDCS) and the other with the anode posterior (a-tsDCS). In study 1, electrically elicited cervicomedullary motor evoked potentials (eCMEPs) and transcranial magnetic stimulation-elicited motor evoked potentials (MEPs) were measured in biceps brachii and flexor carpi radialis before, during and after each tsDCS period. In study 2, eCMEPs and magnetically elicited CMEPs (mCMEPs) were measured before, during and after each tsDCS period. For study 3, computational modelling was used to observe possible interactions of cervical tsDCS and electrical cervicomedullary stimulation. Studies 1 and 2 revealed that eCMEPs were larger during c-tsDCS and smaller during a-tsDCS compared with those elicited when tsDCS was off (P < 0.05), with no changes in MEPs or mCMEPs. Modelling revealed that eCMEP changes might result from modifications of the electrical field direction and magnitude when combined with cervical tsDCS. Bidirectional eCMEP changes are likely to be caused by an interaction between cervical tsDCS and electrical cervicomedullary stimulation; therefore, care should be taken when combining such electrical stimuli in close proximity.

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Transcutaneous spinal DC stimulation reduces pain sensitivity in humans

Cited by 24 publications

References 38 publications

Pilot study of feasibility and effect of anodal transcutaneous spinal direct current stimulation on chronic neuropathic pain after spinal cord injury

Pilot study of feasibility and effect of anodal transcutaneous spinal direct current stimulation on chronic neuropathic pain after spinal cord injury

Anodal Transcutaneous Spinal Direct Current Stimulation (tsDCS) Selectively Inhibits the Synaptic Efficacy of Nociceptive Transmission at Spinal Cord Level

Concurrent electrical cervicomedullary stimulation and cervical transcutaneous spinal direct current stimulation result in a stimulus interaction

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