tDCS as a procedure for chronic pain relief

详细信息    查看全文

• 作者：Luis Garcia-Larrea ; ^{larrea@univ-lyon1.fr" class="auth_mail" title="E-mail the corresponding author} ; ^{luis.garcia-larrea@univ-lyon1.fr" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Pain ; tDCS ; Treatment
• 刊名：Neurophysiologie Clinique / Clinical Neurophysiology
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：46
• 期：3
• 页码：224
• 全文大小：46 K

文摘

Albeit the general notion of cortical activation via external currents has a long history of trials and failures, transcranial direct-current cortex stimulation (tDCS) has only recently been widely introduced as a neuromodulation procedure for the non-pharmacological relief of chronic pain. In non-cephalic pain syndromes, tDCS is most commonly applied over the sensori-motor or dorsolateral prefrontal cortices, via electrodes of about 35 mm² delivering currents not higher than 2 mA. In accordance with a theoretical model establishing that anodal currents tend to activate the underlying (motor) cortex, the anode is commonly placed over the C3/C4 scalp positions, with return of current via a cathode attached to the frontopolar region. Studies on cephalic pain (mainly migraine) have used cathodal stimulation over occipital areas, aimed at inhibiting the occipital cortex. Since current diffusivity when using bipolar montages is important, so-called “focal tDCS” montages are being increasingly used, whereby a number of return points are disposed around the ‘active’ electrode. A recent literature review on tDCS results in more than 1.300 patients treated with tDCS for chronic pain of different aetiologies was unable to propose any ‘A-level’ (i.e. ‘certain efficacy’) recommendation, but suggested a B-level (probable efficacy) of anodal stimulation over M1 in fibromyalgia, and a C-level (possible efficacy) for motor cortex tDCS in neuropathic lower limb pain due to spinal injury. The pain relieving effects of tDCS appear slightly lower than those of rTMS (itself less powerful than epidural stimulation), but some studies have reported tDCS-induced pain relief in patients previously resistant to rTMS. A substantial practical advantage of tDCS is the possibility of implementing home-based stimulation systems, controlled by doctors via an Internet connection, thus avoiding the burden of iterative hospital visits.