Abstract
Background and Aims: Chronic pain is a complex clinical condition, often devastating for patients and unmanageable with pharmacological treatments. Converging evidence suggests that transcutaneous spinal Direct Current Stimulation (tsDCS) might represent a complementary therapy in managing chronic pain. In this randomized, double-blind and sham-controlled crossover study, we assessed tsDCS effects in chronic pain patients.Methods: Sixteen patients (aged 65.06 ± 16.16 years, eight women) with chronic pain of different etiology underwent sham and anodal tsDCS (anode over the tenth thoracic vertebra, cathode over the somatosensory cortical area: 2.5 mA, 20 min, 5 days for 1 week). As outcomes, we considered the Visual Analog Scale (VAS), the Neuropathic Pain Symptom Inventory (NPSI), and the components of the lower limb flexion reflex (LLFR), i.e., RIII threshold, RII latency and area, RIII latency and area, and flexion reflex (FR) total area. Assessments were conducted before (T0), immediately at the end of the treatment (T1), after 1 week (T2) and 1 month (T3).Results: Compared to sham, anodal tsDCS reduced RIII area at T2 (p = 0.0043) and T3 (p = 0.0012); similarly, FR total area was reduced at T3 (p = 0.03). Clinically, anodal tsDCS dampened VAS at T3 (p = 0.015), and NPSI scores at T1 (p = 0.0012), and T3 (p = 0.0015), whereas sham condition left them unchanged. Changes in VAS and NPSI scores linearly correlated with the reduction in LLFR areas (p = 0.0004).Conclusions: Our findings suggest that tsDCS could modulate nociceptive processing and pain perception in chronic pain syndromes.
Highlights
Chronic pain is one of the most intractable clinical problems faced by clinicians and can be devastating for patients [1]
Compared to sham, anodal transcutaneous spinal direct current stimulation (tsDCS) reduced RIII area at T2 (p = 0.0043) and T3 (p = 0.0012); flexion reflex (FR) total area was reduced at T3 (p = 0.03)
Our findings suggest that tsDCS could modulate nociceptive processing and pain perception in chronic pain syndromes
Summary
Chronic pain is one of the most intractable clinical problems faced by clinicians and can be devastating for patients [1]. The mechanisms of action are still to be elucidated, tsDCS likely modulates the supra-spinal excitability, probably in a polarity-dependent manner [23, 24], with anodal tsDCS leading to an impaired intracortical excitability and a functional disconnection between hemispheres [24, 25] In this scenario, Cogiamanian et al [19] found that anodal tsDCS induced lower limb flexion reflex (LLFR) depression in healthy subjects and confirmed that the non-invasive spinal neuromodulatory technique could modulate central nociceptive signal transmission; it might represent a complementary therapy to drugs and invasive spinal cord stimulation (SCS) in managing chronic pain. Double-blind and sham-controlled crossover study, we assessed tsDCS effects in chronic pain patients
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