Abstract
Fibromyalgia is a prevalent chronic pain syndrome characterized by altered pain and
sensory processing in the central nervous system, which is often refractory to multiple
therapeutic approaches. Given previous evidence supporting analgesic properties of
noninvasive brain stimulation techniques in this condition, this study examined the
effects of a novel, more focal method of transcranial direct current stimulation (tDCS),
using the 4×1-ring configuration of high-definition (HD)-tDCS, on overall perceived
pain in fibromyalgia patients. In this patient- and assessor-blind, sham-controlled,
crossover trial, 18 patients were randomized to undergo single 20-minute sessions
of anodal, cathodal, and sham HD-tDCS at 2.0 mA in a counterbalanced fashion. The
center electrode was positioned over the left primary motor cortex. Pain scales and
sensory testing were assessed before and after each intervention. A finite element
method brain model was generated to predict electric field distribution. We found
that both active stimulation conditions led to significant reduction in overall perceived
pain as compared to sham. This effect occurred immediately after cathodal HD-tDCS
and was evident for both anodal and cathodal HD-tDCS 30 minutes after stimulation.
Furthermore, active anodal stimulation induced a significant bilateral increase in
mechanical detection thresholds. These interventions proved well tolerated in our
patient population.
Perspective
4×1-ring HD-tDCS, a novel noninvasive brain stimulation technique capable of more
focal and targeted stimulation, provides significant reduction in overall perceived
pain in fibromyalgia patients as compared to sham stimulation, irrespective of current
polarity. This technique may have other applications in research and clinical settings,
which should be further explored.
Key words
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Article info
Publication history
Published online: February 18, 2013
Accepted:
December 10,
2012
Received in revised form:
December 1,
2012
Received:
July 18,
2012
Footnotes
Funded by a Translational Research Award from the Wallace H. Coulter Foundation.
M.F.V., P.W., J.P., D.Q.T., and F.F. declare no conflicts of interest related to this study. The City University of New York has intellectual property on noninvasive brain stimulation, with M.B. and A.D. as inventors. M.B. and A.D. have equity in Soterix Medical Inc.
Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.
Identification
Copyright
© 2013 American Pain Society. Published by Elsevier Inc. All rights reserved.
