Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20220020
Brazilian Journal of Pain
Original Article

Does anodal transcranial direct current stimulation over left motor cortex show body side pain-related difference in fibromyalgia?

A estimulação transcraniana por corrente contínua anódica sobre o córtex motor esquerdo apresenta diferença na dor entre os hemicorpos na fibromialgia?

Monayane Grazielly Leite Matias; Antônio Felipe Lopes Cavalcante; Karime Andrade Mescouto; Edson Meneses Silva Filho; Abrahão Fontes Baptista; Alexandre Hideki Okano; Rodrigo Pegado

http://dx.doi.org/10.5935/2595-0118.20220020 BrJP, vol.5, n2, p.112-118, 2022
PDF English
PDF Português
SciELO
Downloads: 1
Views: 485

Abstract

BACKGROUND AND OBJECTIVES: Fibromyalgia (FM) is a chronic widespread musculoskeletal pain resulting in central sensitization of nociceptive signaling. Transcranial direct current stimulation (tDCS) over the left motor cortex (M1) is a non-invasive neuromodulation technique indicated for a broad range of chronic pain disorders, including FM. Studies suggest that left and right M1 (contralateral and ipsilateral hemisphere of tDCS stimulation) are modulated. But it is necessary to clarify the differences in clinical pain perception comparing the right and left side of the body. This study aimed to evaluate the pain-related difference between right-left side of the body after five sessions of anodal tDCS in women with FM.

METHODS: A double-blinded, parallel, randomized, sham-controlled trial with 30 women with FM was performed. Five sessions of anodal C3 and cathodal supraorbital (Fp2) tDCS were conducted (2 mA for 20 min). Pain, impact of FM and anxiety were evaluated. No statistically significant three-way interaction between time, stimulation type and body side were found.

RESULTS: Active-tDCS showed significant improvement in pain, but impact of FM and anxiety did not show significant improvement.

CONCLUSION: Five sessions of anodal tDCS over the left M1 improves pain in women with FM, however there was no difference between right-left body sides.

Keywords

Chronic pain, Fibromyalgia, Motor cortex, Noninvasive brain stimulation, Transcranial direct current stimulation

Resumo

JUSTIFICATIVA E OBJETIVOS: A fibromialgia (FM) é uma dor musculoesquelética crônica generalizada que resulta na sensibilização central da sinalização nociceptiva. A estimulação transcraniana de corrente contínua (eTCC) sobre o córtex motor esquerdo (M1) é uma técnica de neuromodulação não invasiva indicada para uma ampla gama de distúrbios de dor crônica, incluindo a FM. Estudos sugerem a modulação do M1 esquerdo e direito (hemisfério contralateral e ipsilateral da eTCC). Mas é necessário esclarecer as diferenças na percepção clínica da dor comparando os lados direito e esquerdo do corpo. Este estudo teve como objetivo avaliar a diferença relacionada à dor entre o lado direito e esquerdo do corpo após cinco sessões de eTCC anodal em mulheres com FM.

MÉTODOS: Foi realizado um estudo duplo-cego, paralelo, randomizado e controlado por sham com 30 mulheres com FM. Foram realizadas cinco sessões de eTCC anodais C3 e supraorbitais catodais (Fp2) (2 mA por 20 min). Foram avaliados a dor, o impacto da FM e a ansiedade. Não foi encontrada nenhuma interação de três vias estatisticamente significativa entre tempo, tipo de estimulação e lado do corpo.

RESULTADOS: A eTCC-Ativa mostrou uma melhora significativa na dor, mas o impacto da FM e da ansiedade não mostrou uma melhora significativa.

CONCLUSÃO: Cinco sessões de eTCC anodal sobre o M1 esquerdo melhoram a dor nas mulheres com FM, entretanto não houve diferença entre os lados direito e esquerdo do corpo.

Palavras-chave

Córtex motor, Dor crônica. Estimulação transcraniana por corrente contínua, Fibromialgia, Síndrome de fadiga crônica

References

Mendonca ME, Simis M, Grecco LC, Battistella LR, Baptista AF, Fregni F. Transcranial direct current stimulation combined with aerobic exercise to optimize analgesic responses in fibromyalgia: a randomized placebo-controlled clinical trial. Front Hum Neurosci. 2016;10:68.

Clauw DJ. Fibromyalgia: a clinical review. JAMA. 2014;311(15):1547-55.

Clauw DJ, Arnold LM, McCarberg BH. The science of fibromyalgia. Mayo Clin Proc. 2011;86(9):907-11.

Rossi S, Santarnecchi E, Valenza G, Ulivelli M. The heart side of brain neuromodulation. Philos. Trans A Math. Phys Eng Sci. 2016;374(2067):20150187.

Heymann RE, Paiva Edos S, Helfenstein Jr M, Pollak DF, Martinez JE, Provenza JR, Paula AP. Brazilian consensus on the treatment of fibromyalgia. Rev Bras Reumatol. 2010;50(1):56-66.

Lefaucheur JP. A comprehensive database of published tDCS clinical trials (2005-2016). Neurophysiol Clin. 2016;46(6):319-98.

Castillo-Saavedra L, Gebodh N, Bikson M, Diaz-Cruz C, Brandao R, Coutinho L. Clinically effective treatment of fibromyalgia pain with high-definition transcranial direct current stimulation: Phase II Open-Label Dose Optimization. J Pain. 2016;17(1):14-26.

Nardone R, Höller Y, Leis S, Höller P, Thon N, Thomschewski A. Invasive and non-invasive brain stimulation for treatment of neuropathic pain in patients with spinal cord injury : a review. . 2014;37(1):19-31.

Zhu CE, Yu B, Zhang W, Chen WH, Qi Q, Miao Y. Effectiveness and safety of transcranial direct current stimulation in fibromyalgia: A systematic review and meta--analysis. J Rehabil Med. 2017;49(1):2-9.

Nasseri P, Nitsche MA, Ekhtiari H. A framework for categorizing electrode montages in transcranial direct current stimulation. Front Hum Neurosci. 2015;9:54.

Lefaucheur JP, Antal A, Ayache SS, Benninger DH, Brunelin J, Cogiamanian F, Cotelli M. Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS). Clin Neurophysiol. 2017;128(1):56-92.

Pellicciari MC, Brignani D, Miniussi C. Excitability modulation of the motor system induced by transcranial direct current stimulation: a multimodal approach. Neuroimage. 2013;83:569-80.

Zheng X, Alsop DC, Schlaug G. Effects of transcranial direct current stimulation (tDCS) on human regional cerebral blood flow. Neuroimage. 2011;58(1):26-33.

Schulz KF, Altman DG, Moher D. CONSORT 2010 Statement: Updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol. 2010;63:834-40.

Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D. Better reporting of interventions: Template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348:g1687.

Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res. 2010;62(5):600-10.

Fregni F, Gimenes R, Valle AC, Ferreira MJ, Rocha RR, Natalle L. A randomized, sham-controlled, proof of principle study of transcranial direct current stimulation for the treatment of pain in fibromyalgia. Arthritis Rheum. 2006;54(12):3988-98.

Bikson M, Grossman P, Thomas C, Zannou AL, Adnan T, Mourdoukoutas AP. Safety of transcranial direct current stimulation: evidence based update 2016. Brain Stimul. 2016;9(5):641-61.

Riberto M, Marcon Alfieri F, Monteiro de Benedetto Pacheco K, Dini Leite V, Nemoto Kaihami H, Fregni F. Efficacy of transcranial direct current stimulation coupled with a multidisciplinary rehabilitation program for the treatment of fibromyalgia. Open Rheumatol J. 2011;5:45-50.

Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990;33(2):160-72.

Marques AP, Barsante Santos AM, Assumpção A, Matsutani LA, Lage LV, Pereira CAB. Validação da versão Brasileira do Fibromyalgia Impact Questionnaire (FIQ). Rev Bras Reumatol. 2006;46(1):24-31.

Hamilton M. Hamilton Anxiety Rating Scale (HAM-A). J Med. 1959;261:81-2.

Björkegren K, Wallander MA, Johansson S, Svärdsudd K. General symptom reporting in female fibromyalgia patients and referents: a population-based case-referent study. BMC Public Health. 2009;9:402.

Ablin J, Fitzcharles MA, Buskila D, Shir Y, Sommer C, Häuser W. Treatment of fibromyalgia syndrome: Recommendations of recent evidence-based interdisciplinary guidelines with special emphasis on complementary and alternative therapies. Evid Based Complement Alternat Med. 2013;2013:485272.

Baptista AF, Fernandes AMBL, Sá KN, Okano AH, Brunoni AR, Lara-Solares A. Latin American and Caribbean consensus on noninvasive central nervous system neuromodulation for chronic pain management (LAC 2 -NIN-CP). Pain Rep. 2019;4(1):e692.

Jensen MP, Day MA, Miró J. Neuromodulatory treatments for chronic pain: efficacy and mechanisms. Nat Rev Neurol. 2014;10(3):167-78.

Morya E, Monte-Silva K, Bikson M, Esmaeilpour Z, Biazoli Jr CE, Fonseca A, Bocci T. Beyond the target area: an integrative view of tDCS-induced motor cortex modulation in patients and athletes. J Neuroeng Rehabil. 2019;16(1):141.

Marlow NM, Bonilha HS, Short EB. Efficacy of transcranial direct current stimulation and repetitive transcranial magnetic stimulation for treating fibromyalgia syndrome: a systematic review. Pain Pract. 2013;13(2):131-45.

Ceko M, Bushnell MC, Gracely RH. Neurobiology underlying fibromyalgia symptoms. Pain Res Treat. 2012;2012:585419.

Matias MGL, Germano Maciel D, França IM, Cerqueira MS, Silva TCLA, Okano AH. Transcranial direct current stimulation associated with functional exercise program for treating fibromyalgia: a randomized controlled trial. Arch Phys Med Rehabil. 2022;103(2):245-54.

Submitted date:
11/27/2021

Accepted date:
04/11/2022

62e054f5a9539520b10972d2 brjp Articles
2595-3192 (Electronic) 2595-0118 (Printed)
BrJP ©2024 All rights reserved.

BrJP

Share this page
Page Sections