Highlights
- •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.
Abstract
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.
Perspective
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.
Key words
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Article info
Publication history
Published online: April 08, 2015
Accepted:
March 28,
2015
Received in revised form:
March 26,
2015
Received:
February 20,
2015
Footnotes
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.
Identification
Copyright
© 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.
