Abstract
The Chikungunya (CHIK) virus is epidemic in Brazil, with 170,000 cases in the first half of 2016. More than 60% of patients present relapsing and remitting chronic arthralgia with debilitating pain lasting years. There are no specific therapeutic agents to treat and rehabilitee infected persons with CHIK. Persistent pain can lead to incapacitation, requiring long-term pharmacological treatment. Advances in non-pharmacological treatments are necessary to promote pain relief without side effects and to restore functionality. Clinical trials indicate transcranial direct current stimulation (tDCS) can treat a broad range of chronic pain disorders, including diffuse neuromuscular pain and arthralgia. Here, we demonstrate that the tDCS across the primary motor cortex significantly reduces pain in the chronic phase of CHIK. High-resolution computational model was created to analyze the cortical electric field generated during tDCS and a diffuse and clustered brain current flow including M1 ipsilateral and contralateral, left DLPFC, nucleus accumbens, and cingulate was found. Our findings suggest tDCS could be an effective, inexpensive and deployable therapy to areas lacking resources with a significant number of patients with chronic CHIK persistent pain.
Highlights
The Chikungunya (CHIK) virus is a mosquito-transmitted alphavirus, first isolated in 1953 during an epidemic in Tanzania[1]
Clinical trials indicate Transcranial Direct Current Stimulation (tDCS) can treat a broad range of chronic pain disorders, including diffuse neuromuscular pain[11,12,13]
Twenty patients in the chronic phase of CHIK were randomized into two groups receiving active-tDCS or sham-tDCS with a “M1 and cathodal contra lateral supraorbital right (M1-SO)” assembly
Summary
The Chikungunya (CHIK) virus is a mosquito-transmitted alphavirus, first isolated in 1953 during an epidemic in Tanzania[1]. Patients infected with CHIK virus will develop persistent rheumatologic and general disabling symptoms such as joint pain, fever, asthenia, headache, retro-orbital pain, photosensitivity, muscular pains, back pain and tenosynovitis[1]. Approximately 5% of patients meet the criteria for chronic inflammatory rheumatism, which may be destructive and deforming with severe pain symptoms and disability[1]. Studies with anodal stimulation of the primary motor cortex (M1) for the treatment of chronic pain syndromes including chronic back pain, fibromyalgia, trigeminal neuralgia, arthrosis and polyneuropathy demonstrated the effectiveness of tDCS on pain and mood symptoms[14,15]. Anodal M1 and cathodal contra lateral supraorbital right (M1-SO) montages of tDCS may treat chronic pain by influencing pain matrix includes motor cortex and deep brain regions producing long-lasting changes in cortical connectivity or excitability. TDCS is a low cost, safe, and mobile intervention that can be deployed on a large scale across locations such as health posts, clinics and in home-visit rehabilitation[19]
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