Abstract
Pain is an under-reported but prevalent symptom in Parkinson’s Disease (PD), impacting patients’ quality of life. Both pain and PD conditions cause cortical excitability reduction and non-invasive brain stimulation. Mental representation techniques are thought to be able to counteract it, also resulting effectively in chronic pain conditions. We aim to conduct two independent studies in order to evaluate the efficacy of transcranial direct current stimulation (tDCS) and mental representation protocol in the management of pain in PD patients during the ON state: (1) tDCS over the Primary Motor Cortex (M1); and (2) Action Observation (AO) and Motor Imagery (MI) training through a Brain-Computer Interface (BCI) using Virtual Reality (AO + MI-BCI). Both studies will include 32 subjects in a longitudinal prospective parallel randomized controlled trial design under different blinding conditions. The main outcomes will be score changes in King’s Parkinson’s Disease Pain Scale, Brief Pain Inventory, Temporal Summation, Conditioned Pain Modulation, and Pain Pressure Threshold. Assessment will be performed pre-intervention, post-intervention, and 15 days post-intervention, in both ON and OFF states.
Highlights
IntroductionThe present study protocol proposes two innovative non-pharmacologic approaches for the treatment of pain in Parkinson’s Disease (PD) patients, which incorporate current knowledge on physiological mechanisms and the clinical results of neuromodulation therapies used in other pain populations
Our studies are very relevant in the quest for an effective non-pharmacological management of pain in Parkinson’s Disease (PD)
This symptom has a high prevalence and impacts negatively in the quality of life of affected subjects. Nowadays this matter becomes even more relevant because lack of physical activity produced because of pandemic mobility restrictions could increase pain. 49.7% of Spanish PD patients report having suffered from pain every day during the COVID-19 pandemic [67]
Summary
The present study protocol proposes two innovative non-pharmacologic approaches for the treatment of pain in PD patients, which incorporate current knowledge on physiological mechanisms and the clinical results of neuromodulation therapies used in other pain populations Both protocols are based on neuromodulation, one of them through non-invasive brain stimulation and the other through mental representation techniques. There are no studies correlating effects of pain non-invasive neuromodulation with complete neuropsychological evaluation including computerized reaction time tasks and extensive neurophysiological measures such as direct cortical excitability evaluation using TMS and connectivity based in EEG entropy analysis. All these features have been described to be altered in PD and Pain. If this hypothesis is confirmed a further analysis of superiority will be proposed among both protocols
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