Highlights
- •An extended period of self-applied transcranial direct current stimulation (tDCS) at home produced improvement in fibromyalgia pain.
- •Findings support the feasibility of home-based tDCS to improve fibromyalgia symptoms.
- •The results provide additional data to use the dorsolateral prefrontal cortex as a target for the treatment of fibromyalgia.
- •The serum brain-derived neurotrophic factor may be a valuable predictor of the magnitude of tDCS on pain scores decreases.
Abstract
This randomized, double-blind controlled trial tested the hypothesis that 60 sessions
of home-based anodal (a)-transcranial direct current stimulation (tDCS) over dorsolateral
prefrontal cortex (DLPFC) would be better than home-based sham-tDCS to improve the
widespread pain and the disability-related to pain. The anodal-tDCS (2 mA for 30 minutes)
over the left DLPFC was self-administered with a specially developed device following
in-person training. Twenty women, 18 to 65 years old were randomized into 2 groups
[active-(a)-tDCS (n = 10) or sham-(s)-tDCS (n = 10)]. Post hoc analysis revealed that
after the first 20 sessions of a-tDCS, the cumulative pain scores reduced by 45.65%
[7.25 (1.43) vs 3.94 (1.14), active vs sham tDCS, respectively]. After 60 sessions,
during the 12-week assessment, pain scores reduced by 62.06% in the actively group
[visual analogue scale reduction, 7.25 (1.43) to 2.75 (.85)] compared to 24.92% in
the s-tDCS group, [mean (SD) 7.10 (1.81) vs 5.33 (.90)], respectively. It reduced
the risk for analgesic use in 55%. Higher serum levels of the brain-derived neurotrophic
factor predicted higher decreases on the pain scores across of treatment.
Perspective
These findings bring 3 important insights: 1) show that an extended period of treatment
(60 sessions, to date the largest number of tDCS sessions tested) for fibromyalgia
induces large pain decreases (a large effect size of 1.59) and 2) support the feasibility
of home-based tDCS as a method of intervention; 3) provide additional data on DLPFC
target for the treatment of fibromyalgia. Finally, our findings also highlight that
brain-derived neurotrophic factor to index neuroplasticity may be a valuable predictor
of the tDCS effect on pain scores decreases across the treatment.
Key words
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Article info
Publication history
Published online: July 26, 2019
Accepted:
June 27,
2019
Received in revised form:
May 23,
2019
Received:
February 17,
2019
Footnotes
Author Contributions: A.B., F.C., and W.C. had substantial contributions to the conception or design of the work. M.Z., P.S., D.S., F.F., and W.C. drafted the work or revised it critically for important intellectual content. All the authors agree and approve the final version of this work.
Conflict of Interest Statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Disclosures Section: The present research was supported by the following Brazilian funding agencies: 1) Committee for the Development of Higher Education Personnel—CAPES - PNPD (grant to MZ with Post doctorate scholarship, Grant #2015; AB, FC). 2) National Council for Scientific and Technological Development – CNPq (grant 301256/2013-6 to Dr. W.C.). 3) Post graduate Program in Medical Sciences of Medical School of the Federal University of Rio Grande do Sul. 4) Post graduate Research Group at the Hospital de Clínicas de Porto Alegre (CAAE 35753214.4.0000.5327, A.S., P.S., and D.S.). 5) Foundation for Support of Research at Rio Grande do Sul (FAPERGS). Brazilian Innovation Agency (FINEP [Financiadora de Estudos e Projetos]); process number 1245/13 to Iraci LS Torres, Wolnei Caumo and Paulo R S Sanches). Grant (FAPERGS-PRONEM: no. 16/2551-0000249-5 - Paulo R S Sanches). WC, FF agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Trial Registration: Number NCT02652988.
Identification
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© 2019 by United States Association for the Study of Pain, Inc.
