Effectiveness of transcranial direct current stimulation and visual illusion on neuropathic pain in spinal cord injury

被引:210
作者
Dolors Soler, Maria [1 ]
Kumru, Hatice [1 ]
Pelayo, Raul [1 ]
Vidal, Joan [1 ]
Maria Tormos, Josep [1 ]
Fregni, Felipe [2 ,3 ]
Navarro, Xavier [4 ]
Pascual-Leone, Alvaro [1 ,2 ,3 ]
机构
[1] Univ Autonoma Barcelona, Inst Guttmann, Hosp Neurorehabil, Inst Univ, Barcelona 08916, Badalona, Spain
[2] Beth Israel Deaconess Med Ctr, Berenson Allen Ctr Noninvas Brain Stimulat, Dept Neurol, Boston, MA 02215 USA
[3] Harvard Univ, Sch Med, Boston, MA 02215 USA
[4] Univ Autonoma Barcelona, Inst Neurociencies, Bellaterra 08193, Spain
基金
美国国家卫生研究院;
关键词
spinal cord injury; neuropathic pain; transcranial direct current stimulation; visual illusion; CORTICAL MOTOR OUTPUT; CORTICOSPINAL EXCITABILITY; ELECTRICAL-STIMULATION; CLINICAL IMPORTANCE; NEURONAL-ACTIVITY; SYSTEM FUNCTION; DC STIMULATION; PHANTOM LIMBS; CORTEX; IMAGERY;
D O I
10.1093/brain/awq184
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
The aim of this study was to evaluate the analgesic effect of transcranial direct current stimulation of the motor cortex and techniques of visual illusion, applied isolated or combined, in patients with neuropathic pain following spinal cord injury. In a sham controlled, double-blind, parallel group design, 39 patients were randomized into four groups receiving transcranial direct current stimulation with walking visual illusion or with control illusion and sham stimulation with visual illusion or with control illusion. For transcranial direct current stimulation, the anode was placed over the primary motor cortex. Each patient received ten treatment sessions during two consecutive weeks. Clinical assessment was performed before, after the last day of treatment, after 2 and 4 weeks follow-up and after 12 weeks. Clinical assessment included overall pain intensity perception, Neuropathic Pain Symptom Inventory and Brief Pain Inventory. The combination of transcranial direct current stimulation and visual illusion reduced the intensity of neuropathic pain significantly more than any of the single interventions. Patients receiving transcranial direct current stimulation and visual illusion experienced a significant improvement in all pain subtypes, while patients in the transcranial direct current stimulation group showed improvement in continuous and paroxysmal pain, and those in the visual illusion group improved only in continuous pain and dysaesthesias. At 12 weeks after treatment, the combined treatment group still presented significant improvement on the overall pain intensity perception, whereas no improvements were reported in the other three groups. Our results demonstrate that transcranial direct current stimulation and visual illusion can be effective in the management of neuropathic pain following spinal cord injury, with minimal side effects and with good tolerability.
引用
收藏
页码:2565 / 2577
页数:13
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