Abstract
In this study we aimed to determine current distribution and short-term analgesic
effects of transcranial direct current stimulation (tDCS) in fibromyalgia using different
electrode montages. For each electrode montage, clinical effects were correlated with
predictions of induced cortical current flow using magnetic resonance imaging–derived
finite element method head model. Thirty patients were randomized into 5 groups (Cathodal-M1
[primary motor cortex], Cathodal-SO [supra-orbital area], Anodal-M1, Anodal-SO, and
Sham) to receive tDCS application (2 mA, 20 minutes) using an extracephalic montage.
Pain was measured using a visual numerical scale (VNS), pressure pain threshold (PPT),
and a body diagram (BD) evaluating pain area. There was significant pain reduction
in cathodal-SO and anodal-SO groups indexed by VNS. For PPT there was a trend for
a similar effect in anodal-SO group. Computer simulation indicated that the M1-extracephalic
montage produced dominantly temporo-parietal current flow, consistent with lack of
clinical effects with this montage. Conversely, the SO-extracephalic montage produced
current flow across anterior prefrontal structures, thus supporting the observed analgesic
effects. Our clinical and modeling findings suggest that electrode montage, considering
both electrodes, is critical for the clinical effects of M1-tDCS as electric current
needs to be induced in areas associated with the pain matrix. These results should
be taken into consideration for the design of pain tDCS studies.
Perspective
Results in this article support that electrode montage is a critical factor to consider
for the clinical application of tDCS for pain control, as there is an important correlation
between the location of induced electrical current and tDCS-induced analgesic effects.
Key words
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Article Info
Publication History
Published online: April 18, 2011
Accepted:
December 31,
2010
Received in revised form:
December 19,
2010
Received:
August 14,
2010
Footnotes
F.F. is supported by grant from NIH R21DK081773 .
The authors have no conflicts of interest.
Identification
Copyright
© 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.
