- •Five days of transcranial direct current stimulation (tDCS) over the motor cortex induces a sustained phantom limb pain relief.
- •An immediate improvement of phantom limb pain and movement is brought about by tDCS.
- •Phantom limb pain relief is linked to increased movement of the phantom limb.
- •Neuromodulation may be helpful for the management of phantom limb pain.
The study explored the analgesic effects of transcranial direct current stimulation (tDCS) over the motor cortex on postamputation phantom limb pain (PLP). Eight subjects with unilateral lower or upper limb amputation and chronic PLP were enrolled in a crossover, double-blind, sham-controlled treatment program. For 5 consecutive days, anodal (active or sham) tDCS was applied over the motor cortex for 15 minutes at an intensity of 1.5 mA. The 5-day treatment with active, but not sham, tDCS induced a sustained decrease in background PLP and in the frequency of PLP paroxysms, which lasted for 1 week after the end of treatment. Moreover, on each day of active tDCS, patients reported an immediate PLP relief, along with an increased ability to move their phantom limb. Patients' immediate responses to sham tDCS, on the contrary, were variable, marked by an increase or decrease of PLP levels from baseline. These results show that a 5-day treatment of motor cortex stimulation with tDCS can induce stable relief from PLP in amputees. Neuromodulation targeting the motor cortex appears to be a promising option for the management of this debilitating neuropathic pain condition, which is often refractory to classic pharmacologic and surgical treatments.
The study describes sustained and immediate effects of motor cortex stimulation by tDCS on postamputation PLP, whose analgesic action seems linked to the motor reactivation of the phantom limb. These results are helpful for the exploitation of tDCS as a therapeutic tool for the management of neuropathic pain.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to The Journal of Pain
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Therapeutic time window of non-invasive brain stimulation for pain treatment: Inhibition of maladaptive plasticity with early treatment intervention.Expert Rev Med Devices. 2013; 10: 339-352
- An inventory for measuring depression.Arch Gen Psychiatry. 1961; 4: 561-571
- Improving ideomotor limb apraxia by electrical stimulation of the left posterior parietal cortex.Brain. 2015; 138: 428-439
- Motor and parietal cortex stimulation for phantom limb pain and sensations.Pain. 2013; 154: 1274-1280
- Long-term analgesic effects of transcranial direct current stimulation of the motor cortex on phantom limb and stump pain: A case report.J Pain Symptom Manage. 2013; 46: e1-e4
- Clinical research with transcranial direct current stimulation (tDCS): Challenges and future directions.Brain Stimul. 2012; 5: 175-195
- Mechanisms of cortical reorganization in lower-limb amputees.J Neurosci. 1998; 18: 3443-3450
- Eta-squared and partial eta-squared in fixed factor ANOVA designs.Educ Psychol Meas. 1973; 33: 107-112
- Motor reorganization after upper limb amputation in man. A study with focal magnetic stimulation.Brain. 1991; 114: 615-627
- Increased excitability in the primary motor cortex and supplementary motor area in patients with phantom limb pain after upper limb amputation.Neurosci Lett. 2001; 307: 109-112
- Immediate effects of tDCS on the mu-opioid system of a chronic pain patient.Front Psychiatry. 2012; 3: 93
- Phantom-limb pain: Characteristics, causes, and treatment.Lancet Neurol. 2002; 1: 182-189
- Phantom limb pain: A case of maladaptive CNS plasticity?.Nat Rev Neurosci. 2006; 7: 873-881
- Mini-mental state. A practical method for grading the cognitive state of patients for the clinician.J Psychiatr Res. 1975; 12: 189-198
- 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
- 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
- Motor control over the phantom limb in above-elbow amputees and its relationship with phantom limb pain.Neuroscience. 2009; 162: 78-86
- Transcranial DC stimulation (tDCS): A tool for double-blind sham-controlled clinical studies in brain stimulation.Clin Neurophysiol. 2006; 117: 845-850
- Positron emission tomography during motor cortex stimulation for pain control.Stereotact Funct Neurosurg. 1997; 68: 141-148
- Electrical stimulation of motor cortex for pain control: A combined PET-scan and electrophysiological study.Pain. 1999; 83: 259-273
- Illusory movements of the paralyzed limb restore motor cortex activity.Neuroimage. 2003; 20: S107-S111
- Immediate and long-term phantom limb pain in amputees: Incidence, clinical characteristics and relationship to pre-amputation limb pain.Pain. 1985; 21: 267-278
- Plasticity of sensory and motor maps in adult mammals.Annu Rev Neurosci. 1991; 14: 137-167
- Reorganization of motor and somatosensory cortex in upper extremity amputees with phantom limb pain.J Neurosci. 2001; 21: 3609-3618
- Management of phantom pain with a textile, electromagnetically-acting stump liner: A randomized, double-blind, crossover study.J Pain Symptom Manage. 2006; 32: 352-360
- Putative physiological mechanisms underlying tDCS analgesic effects.Front Hum Neurosci. 2013; 7: 628
- Phantom pain and phantom sensations in upper limb amputees: An epidemiological study.Pain. 2000; 87: 33-41
- 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
- Pain. Handbook of Clinical Neurology. vol. 116. 2013: 423-440
- Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS).Clin Neurophysiol. 2014; 125: 2150-2206
- Somatotopic organization of the analgesic effects of motor cortex rTMS in neuropathic pain.Neurology. 2006; 67: 1998-2004
- Transcranial direct current stimulation for the reduction of clinical and experimentally induced pain: A systematic review and meta-analysis.Clin J Pain. 2012; 28: 452-461
- Managing phantom pain.Pain Physician. 2004; 7: 365-375
- Interactions between pain and the motor cortex: insights from research on insights from research on phantom limb pain and complex regional pain syndrome.Physiother Can. 2011; 63: 305-314
- Mapping phantom movement representations in the motor cortex of amputees.Brain. 2006; 129: 2202-2210
- Training with virtual visual feedback to alleviate phantom limb pain.Neurorehabil Neural Repair. 2009; 23: 587-594
- Somatosensory cortical map changes following digit amputation in adult monkeys.J Comp Neurol. 1984; 224: 591-605
- Targeting cortical representations in the treatment of chronic pain: A review.Neurorehabil Neural Repair. 2012; 26: 646-652
- Rethinking clinical trials of transcranial direct current stimulation: participant and assessor blinding is inadequate at intensities of 2 mA.PLoS One. 2012; 7: e47514
- Non-invasive brain stimulation techniques for chronic pain.Cochrane Database Syst Rev. 2014; : CD008208
- Motor cortex stimulation in neuropathic pain. Correlations between analgesic effect and hemodynamic changes in the brain. A PET study.Neuroimage. 2007; 34: 310-321
- Massive cortical reorganization after sensory deafferentation in adult macaques.Science. 1991; 252: 1857-1860
- Safety aspects of transcranial direct current stimulation concerning healthy subjects and patients.Brain Res Bull. 2007; 72: 208-214
- The use of visual feedback, in particular mirror visual feedback, in restoring brain function.Brain. 2009; 132: 1693-1710
- Persistent hand motor commands in the amputees' brain.Brain. 2006; 129: 2211-2223
- The motor cortex and its role in phantom limb phenomena.Neuroscientist. 2008; 14: 195-202
- Reorganisation in human motor cortex.Can J Physiol Pharmacol. 1995; 73: 218-222
- Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research.Clin Neurophysiol. 2009; 120: 2008-2039
Published online: April 08, 2015
Accepted: March 28, 2015
Received in revised form: March 26, 2015
Received: February 20, 2015
Supported by the institutional fund ATE (2009-ATE-0293) from the University of Milano-Bicocca to N.B. and A.M.
The authors report no conflict of interest.
© 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.