Abstract
Introduction: The transcranial direct current stimulation (tDCS) is a neuromodulatory technique with the potential to decrease pain scores and to improve chronic pain treatment. Although age is an essential factor that might impact the tDCS effect, most studies are solely conducted in adults. Therefore, the age limitation presents a critical research gap in this field and can be shown by only a handful of studies that have included other age groups. To examine the evidence upon the tDCS effect on pain scores on children, adolescents, or elderly, and indirectly, to infer the age-dependent impact on tDCS effects, we conducted a systematic review and meta-analysis.Methods: A systematic review searching the following databases: PubMed, EMBASE, and Science Direct using the following search terms adapted according to MeSh or Entree: [(“Adolescent” OR “Children” OR “Elderly”) AND (“tDCS”) AND (“Pain” OR “Pain threshold”) AND (“dorsolateral prefrontal cortex” OR “Motor cortex)] up to April 20th, 2020. We retrieved 228 articles, 13 were included in the systematic review, and five studies with elderly subjects that had their outcomes assessed by pain score or pain threshold were included in the meta-analysis.Results: For the analysis of pain score, 96 individuals received active stimulation, and we found a favorable effect for active tDCS to reduce pain score compared to sham (P = 0.002). The standardized difference was −0.76 (CI 95% = −1.24 to −0.28). For the pain threshold, the analysis showed no significant difference between active and sham tDCS. We reviewed two studies with adolescents: one study using anodal tDCS over the prefrontal cortex reported a reduction in pain scores. However, the second study reported an increase in pain sensitivity for the dorsolateral prefrontal cortex (DLPFC) stimulation.Conclusion: Our findings suggest tDCS may reduce pain levels in the elderly group. Nevertheless, the small number of studies included in this review—and the considerable heterogeneity for clinical conditions and protocols of stimulation present—limits the support of tDCS use for pain treatment in elderly people. Larger studies on the tDCS effect on pain are needed to be conducted in elderly and adolescents, also evaluating different montages and electrical current intensity.
Highlights
The transcranial direct current stimulation is a neuromodulatory technique with the potential to decrease pain scores and to improve chronic pain treatment
Given the emerging importance of transcranial direct current stimulation (tDCS) as a potential treatment for chronic pain conditions, we have reviewed the current understanding of tDCS for pain in less studied age groups: children, adolescents, and elderly people
Regarding the a-tDCS effect on different clinical syndromes, a study included in this review showed that the impact on a pain level of a-tDCS was distinct for different subgroups of non-inflammatory musculoskeletal pain, including neck and upper extremity pain, low back pain, and lower extremity pain
Summary
The transcranial direct current stimulation (tDCS) is a neuromodulatory technique with the potential to decrease pain scores and to improve chronic pain treatment. Age is an essential factor that might impact the tDCS effect, most studies are solely conducted in adults. The main mechanism of acute pain is tissue injury This is a critical point that should be considered as part of the diagnostic criteria besides continuous or recurrent pain for more than 3 months (Raja et al, 2020). According to a survey conducted in 2016, over 20% of American adults suffered from chronic pain, and 8% presented high-impact pain, which is classified when pain is associated with limiting life or work activities (Dahlhamer et al, 2018). The presence of chronic pain in this age group has a negative impact on quality of life, damaging the social, recreational, and academic domains, being a major cause of absenteeism in children and adolescents. Chronic pain is associated with increased school abstention (Groenewald et al, 2019), and, as shown by prospective cohort studies, chronic pain in adolescents was associated with lower education levels in adulthood, worse career positioning, and other social impacts such as early parenthood and a worse quality in affective relationships (Murray et al, 2020)
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