Abstract
Pain modulation can be achieved using neuromodulatory tools that influence various
levels of the nervous system. Transcranial direct current stimulation (tDCS), for
instance, has been shown to reduce chronic pain when applied to the primary motor
cortex. In contrast to this central neuromodulatory technique, diffuse noxious inhibitory
controls (DNIC) refers to endogenous analgesic mechanisms that decrease pain following
the introduction of heterotopic noxious stimuli. We examined whether combining top-down
motor cortex modulation using anodal tDCS with a bottom-up DNIC induction paradigm
synergistically increases the threshold at which pain is perceived. The pain thresholds
of 15 healthy subjects were assessed before and after administration of active tDCS,
sham tDCS, cold-water-induced DNIC, and combined tDCS and DNIC. We found that both
tDCS and the DNIC paradigm significantly increased pain thresholds and that these
approaches appeared to have additive effects. Increase in pain threshold following
active tDCS was positively correlated with baseline N-acetylaspartate in the cingulate
cortex and negatively correlated with baseline glutamine levels in the thalamus as
measured by magnetic resonance spectroscopy. These results suggest that motor cortex
modulation may have a greater analgesic effect when combined with bottom-up neuromodulatory
mechanisms, presenting new avenues for modulation of pain using noninvasive neuromodulatory
approaches.
Perspective
This article demonstrates that both noninvasive motor cortex modulation and a descending
noxious inhibitory controls paradigm significantly increase pain thresholds in healthy
subjects and appear to have an additive effect when combined. These results suggest
that existing pain therapies involving DNIC may be enhanced through combination with
noninvasive brain stimulation.
Key words
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Article info
Publication history
Published online: April 20, 2012
Accepted:
January 21,
2012
Received in revised form:
December 14,
2011
Received:
September 27,
2011
Footnotes
Partially funded by grant number R21 7R21DK081773 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at the National Institutes of Health. The contents of the publication are solely the responsibility of the authors and do not necessarily represent the official views of NIDDK.
The authors report no conflicts of interest.
Identification
Copyright
© 2012 American Pain Society. Published by Elsevier Inc. All rights reserved.
