The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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Transcranial direct current stimulation for spinal cord injury-associated neuropathic pain

  • Li, Caixia (Department of Anesthesiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine) ;
  • Jirachaipitak, Sukunya (Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Wrigley, Paul (Pain Management Research Institute, Faculty of Medicine and Health, Northern Clinical School, The University of Sydney) ;
  • Xu, Hua (Department of Anesthesiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine) ;
  • Euasobhon, Pramote (Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University)
  • Received : 2020.10.26
  • Accepted : 2020.12.30
  • Published : 2021.04.01
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Abstract

Several types of pain occur following spinal cord injury (SCI); however, neuropathic pain (NP) is one of the most intractable. Invasive and non-invasive brain stimulation techniques have been studied in clinical trials to treat chronic NP following SCI. The evidence for invasive stimulation including motor cortex and deep brain stimulation via the use of implanted electrodes to reduce SCI-related NP remains limited, due to the small scale of existing studies. The lower risk of complications associated with non-invasive stimulation, including transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), provide potentially attractive alternative central neuromodulation techniques. Compared to rTMS, tDCS is technically easier to apply, more affordable, available, and potentially feasible for home use. Accordingly, several new studies have investigated the efficacy of tDCS to treat NP after SCI. In this review, articles relating to the mechanisms, clinical efficacy and safety of tDCS on SCI-related NP were searched from inception to December 2019. Six clinical trials, including five randomized placebo-controlled trials and one prospective controlled trial, were included for evidence specific to the efficacy of tDCS for treating SCI-related NP. The mechanisms of action of tDCS are complex and not fully understood. Several factors including stimulation parameters and individual patient characteristics may affect the efficacy of tDCS intervention. Current evidence to support the efficacy of utilizing tDCS for relieving chronic NP after SCI remains limited. Further strong evidence is needed to confirm the efficacy of tDCS intervention for treating SCI-related NP.

Keywords

References

  1. Hatch MN, Cushing TR, Carlson GD, Chang EY. Neuropathic pain and SCI: identification and treatment strategies in the 21st century. J Neurol Sci 2018; 384: 75-83. https://doi.org/10.1016/j.jns.2017.11.018
  2. Siddall PJ, Taylor DA, McClelland JM, Rutkowski SB, Cousins MJ. Pain report and the relationship of pain to physical factors in the first 6 months following spinal cord injury. Pain 1999; 81: 187-97. https://doi.org/10.1016/S0304-3959(99)00023-8
  3. Davari M, Amani B, Amani B, Khanijahani A, Akbarzadeh A, Shabestan R. Pregabalin and gabapentin in neuropathic pain management after spinal cord injury: a systematic review and meta-analysis. Korean J Pain 2020; 33: 3-12. https://doi.org/10.3344/kjp.2020.33.1.3
  4. Widerstrom-Noga EG, Duncan R, Felipe-Cuervo E, Turk DC. Assessment of the impact of pain and impairments associated with spinal cord injuries. Arch Phys Med Rehabil 2002; 83: 395-404. https://doi.org/10.1053/apmr.2002.28028
  5. Finnerup NB, Yezierski RP, Sang CN, Burchiel KJ, Jensen TS. Treatment of spinal cord injury pain. Pain Clin Updates 2001; 9: 1-6.
  6. Wallace BA, Ashkan K, Benabid AL. Deep brain stimulation for the treatment of chronic, intractable pain. Neurosurg Clin N Am 2004; 15: 343-57. https://doi.org/10.1016/j.nec.2004.03.004
  7. Chari A, Hentall ID, Papadopoulos MC, Pereira EA. Surgical neurostimulation for spinal cord injury. Brain Sci 2017; 7: 18. https://doi.org/10.3390/brainsci7020018
  8. Lefaucheur JP, Antal A, Ahdab R, Ciampi de Andrade D, Fregni F, Khedr EM, et al. The use of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) to relieve pain. Brain Stimul 2008; 1: 337-44. https://doi.org/10.1016/j.brs.2008.07.003
  9. Costain R, Redfearn JW, Lippold OC. A controlled trial of the therapeutic effect of polarization of the brain in depressive illness. Br J Psychiatry 1964; 110: 786-99. https://doi.org/10.1192/bjp.110.469.786
  10. Miniussi C, Cappa SF, Cohen LG, Floel A, Fregni F, Nitsche MA, et al. Efficacy of repetitive transcranial magnetic stimulation/transcranial direct current stimulation in cognitive neurorehabilitation. Brain Stimul 2008; 1: 326-36. https://doi.org/10.1016/j.brs.2008.07.002
  11. Nitsche MA, Cohen LG, Wassermann EM, Priori A, Lang N, Antal A, et al. Transcranial direct current stimulation: state of the art 2008. Brain Stimul 2008; 1: 206-23. https://doi.org/10.1016/j.brs.2008.06.004
  12. Fregni F, Pascual-Leone A. Technology insight: noninvasive brain stimulation in neurology-perspectives on the therapeutic potential of rTMS and tDCS. Nat Clin Pract Neurol 2007; 3: 383-93. https://doi.org/10.1038/ncpneuro0530
  13. George MS, Aston-Jones G. Noninvasive techniques for probing neurocircuitry and treating illness: vagus nerve stimulation (VNS), transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). Neuropsychopharmacology 2010; 35: 301-16. https://doi.org/10.1038/npp.2009.87
  14. Fregni F, Nitsche MA, Loo CK, Brunoni AR, Marangolo P, Leite J, et al. Regulatory considerations for the clinical and research use of transcranial direct current stimulation (tDCS): review and recommendations from an expert panel. Clin Res Regul Aff 2015; 32: 22-35. https://doi.org/10.3109/10601333.2015.980944
  15. Fregni F, Boggio PS, Lima MC, Ferreira MJ, Wagner T, Rigonatti SP, et al. A sham-controlled, phase II trial of transcranial direct current stimulation for the treatment of central pain in traumatic spinal cord injury. Pain 2006; 122: 197-209. https://doi.org/10.1016/j.pain.2006.02.023
  16. Soler MD, Kumru H, Pelayo R, Vidal J, Tormos JM, Fregni F, et al. Effectiveness of transcranial direct current stimulation and visual illusion on neuropathic pain in spinal cord injury. Brain 2010; 133: 2565-77. https://doi.org/10.1093/brain/awq184
  17. Wrigley PJ, Gustin SM, McIndoe LN, Chakiath RJ, Henderson LA, Siddall PJ. Longstanding neuropathic pain after spinal cord injury is refractory to transcranial direct current stimulation: a randomized controlled trial. Pain 2013; 154: 2178-84. https://doi.org/10.1016/j.pain.2013.06.045
  18. Ngernyam N, Jensen MP, Arayawichanon P, Auvichayapat N, Tiamkao S, Janjarasjitt S, et al. The effects of transcranial direct current stimulation in patients with neuropathic pain from spinal cord injury. Clin Neurophysiol 2015; 126: 382-90. https://doi.org/10.1016/j.clinph.2014.05.034
  19. Yoon EJ, Kim YK, Kim HR, Kim SE, Lee Y, Shin HI. Transcranial direct current stimulation to lessen neuropathic pain after spinal cord injury: a mechanistic PET study. Neurorehabil Neural Repair 2014; 28: 250-9. https://doi.org/10.1177/1545968313507632
  20. Thibaut A, Carvalho S, Morse LR, Zafonte R, Fregni F. Delayed pain decrease following M1 tDCS in spinal cord injury: a randomized controlled clinical trial. Neurosci Lett 2017; 658: 19-26. https://doi.org/10.1016/j.neulet.2017.08.024
  21. Lefaucheur JP, Antal A, Ayache SS, Benninger DH, Brunelin J, Cogiamanian F, et al. Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS). Clin Neurophysiol 2017; 128: 56-92. https://doi.org/10.1016/j.clinph.2016.10.087
  22. Nitsche MA, Paulus W. Sustained excitability elevations induced by transcranial DC motor cortex stimulation in humans. Neurology 2001; 57: 1899-901. https://doi.org/10.1212/WNL.57.10.1899
  23. Anastassiou CA, Perin R, Markram H, Koch C. Ephaptic coupling of cortical neurons. Nat Neurosci 2011; 14: 217-23. https://doi.org/10.1038/nn.2727
  24. Nitsche MA, Muller-Dahlhaus F, Paulus W, Ziemann U. The pharmacology of neuroplasticity induced by non-invasive brain stimulation: building models for the clinical use of CNS active drugs. J Physiol 2012; 590: 4641-62. https://doi.org/10.1113/jphysiol.2012.232975
  25. Knotkova H, Nitsche MA, Cruciani RA. Putative physiological mechanisms underlying tDCS analgesic effects. Front Hum Neurosci 2013; 7: 628. https://doi.org/10.3389/fnhum.2013.00628
  26. Nitsche MA, Fricke K, Henschke U, Schlitterlau A, Liebetanz D, Lang N, et al. Pharmacological modulation of cortical excitability shifts induced by transcranial direct current stimulation in humans. J Physiol 2003; 553(Pt 1): 293-301. https://doi.org/10.1113/jphysiol.2003.049916
  27. Liebetanz D, Nitsche MA, Tergau F, Paulus W. Pharmacological approach to the mechanisms of transcranial DC-stimulation-induced after-effects of human motor cortex excitability. Brain 2002; 125(Pt 10): 2238-47. https://doi.org/10.1093/brain/awf238
  28. D'Angelo E, Rossi P. Integrated regulation of signal coding and plasticity by NMDA receptors at a central synapse. Neural Plast 1998; 6: 8-16. https://doi.org/10.1155/NP.1998.8
  29. Nitsche MA, Jaussi W, Liebetanz D, Lang N, Tergau F, Paulus W. Consolidation of human motor cortical neuroplasticity by D-cycloserine. Neuropsychopharmacology 2004; 29: 1573-8. https://doi.org/10.1038/sj.npp.1300517
  30. Nitsche MA, Liebetanz D, Schlitterlau A, Henschke U, Fricke K, Frommann K, et al. GABAergic modulation of DC stimulation-induced motor cortex excitability shifts in humans. Eur J Neurosci 2004; 19: 2720-6. https://doi.org/10.1111/j.0953-816X.2004.03398.x
  31. Stagg CJ, Best JG, Stephenson MC, O'Shea J, Wylezinska M, Kincses ZT, et al. Polarity-sensitive modulation of cortical neurotransmitters by transcranial stimulation. J Neurosci 2009; 29: 5202-6. https://doi.org/10.1523/JNEUROSCI.4432-08.2009
  32. Rango M, Cogiamanian F, Marceglia S, Barberis B, Arighi A, Biondetti P, et al. Myoinositol content in the human brain is modified by transcranial direct current stimulation in a matter of minutes: a 1H-MRS study. Magn Reson Med 2008; 60: 782-9. https://doi.org/10.1002/mrm.21709
  33. Ardolino G, Bossi B, Barbieri S, Priori A. Non-synaptic mechanisms underlie the after-effects of cathodal transcutaneous direct current stimulation of the human brain. J Physiol 2005; 568(Pt 2): 653-63. https://doi.org/10.1113/jphysiol.2005.088310
  34. Lang N, Siebner HR, Ward NS, Lee L, Nitsche MA, Paulus W, et al. How does transcranial DC stimulation of the primary motor cortex alter regional neuronal activity in the human brain? Eur J Neurosci 2005; 22: 495-504. https://doi.org/10.1111/j.1460-9568.2005.04233.x
  35. DosSantos MF, Love TM, Martikainen IK, Nascimento TD, Fregni F, Cummiford C, et al. Immediate effects of tDCS on the μ-opioid system of a chronic pain patient. Front Psychiatry 2012; 3: 93. https://doi.org/10.3389/fpsyt.2012.00093
  36. Nitsche MA, Kuo MF, Karrasch R, Wachter B, Liebetanz D, Paulus W. Serotonin affects transcranial direct current-induced neuroplasticity in humans. Biol Psychiatry 2009; 66: 503-8. https://doi.org/10.1016/j.biopsych.2009.03.022
  37. Kuo MF, Paulus W, Nitsche MA. Boosting focally-induced brain plasticity by dopamine. Cereb Cortex 2008; 18: 648-51. https://doi.org/10.1093/cercor/bhm098
  38. Souza A, Martins DF, Medeiros LF, Nucci-Martins C, Martins TC, Siteneski A, et al. Neurobiological mechanisms of antiallodynic effect of transcranial direct current stimulation (tDCS) in a mice model of neuropathic pain. Brain Res 2018; 1682: 14-23. https://doi.org/10.1016/j.brainres.2017.12.005
  39. Pelletier SJ, Cicchetti F. Cellular and molecular mechanisms of action of transcranial direct current stimulation: evidence from in vitro and in vivo models. Int J Neuropsychopharmacol 2014; 18: pyu047. https://doi.org/10.1093/ijnp/pyu047
  40. Nitsche MA, Paulus W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol 2000; 527(Pt 3): 633-9. https://doi.org/10.1111/j.1469-7793.2000.t01-1-00633.x
  41. Antal A, Terney D, Poreisz C, Paulus W. Towards unravelling task-related modulations of neuroplastic changes induced in the human motor cortex. Eur J Neurosci 2007; 26: 2687-91. https://doi.org/10.1111/j.1460-9568.2007.05896.x
  42. Mehta S, McIntyre A, Guy S, Teasell RW, Loh E. Effectiveness of transcranial direct current stimulation for the management of neuropathic pain after spinal cord injury: a metaanalysis. Spinal Cord 2015; 53: 780-5. https://doi.org/10.1038/sc.2015.118
  43. McLaren ME, Nissim NR, Woods AJ. The effects of medication use in transcranial direct current stimulation: a brief review. Brain Stimul 2018; 11: 52-8. https://doi.org/10.1016/j.brs.2017.10.006
  44. Muller-Dahlhaus JF, Orekhov Y, Liu Y, Ziemann U. Interindividual variability and age-dependency of motor cortical plasticity induced by paired associative stimulation. Exp Brain Res 2008; 187: 467-75. https://doi.org/10.1007/s00221-008-1319-7
  45. Sale MV, Ridding MC, Nordstrom MA. Cortisol inhibits neuroplasticity induction in human motor cortex. J Neurosci 2008; 28: 8285-93. https://doi.org/10.1523/JNEUROSCI.1963-08.2008
  46. Cheeran B, Talelli P, Mori F, Koch G, Suppa A, Edwards M, et al. A common polymorphism in the brain-derived neurotrophic factor gene (BDNF) modulates human cortical plasticity and the response to rTMS. J Physiol 2008; 586: 5717-25. https://doi.org/10.1113/jphysiol.2008.159905
  47. Brunoni AR, Amadera J, Berbel B, Volz MS, Rizzerio BG, Fregni F. A systematic review on reporting and assessment of adverse effects associated with transcranial direct current stimulation. Int J Neuropsychopharmacol 2011; 14: 1133-45. https://doi.org/10.1017/S1461145710001690
  48. Antal A, Alekseichuk I, Bikson M, Brockmoller J, Brunoni AR, Chen R, et al. Low intensity transcranial electric stimulation: safety, ethical, legal regulatory and application guidelines. Clin Neurophysiol 2017; 128: 1774-809. https://doi.org/10.1016/j.clinph.2017.06.001
  49. Oliveira LB, Lopes TS, Soares C, Maluf R, Goes BT, Sa KN, et al. Transcranial direct current stimulation and exercises for treatment of chronic temporomandibular disorders: a blind randomised-controlled trial. J Oral Rehabil 2015; 42: 723-32. https://doi.org/10.1111/joor.12300

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