Delayed pain decrease following M1 tDCS in spinal cord injury: A randomized controlled clinical trial

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Study assessed the direct and long-term effects of transcranial direct current stimulation (tDCS) of the primary motor cortex (M1) on pain, quality of life (QOL), and life satisfaction following spinal cord injury (SCI). A two-phase randomized sham-controlled clinical trial was performed in which patients received 5 days of tDCS followed by a 3-month follow-up period (Phase I); then, Phase II consisted of 10 days of tDCS with an 8-week follow-up period. Level of pain was assessed with the visual analogue scale. Patients’ QOL and life satisfaction were also evaluated using the Patient Health Questionnaire (PHQ-9) and the Satisfaction With Life Scale (SWLS), respectively. Thirty-three patients were randomized to receive either active or sham tDCS in Phase I and 9 patients were enrolled in Phase II. Linear regression models showed a treatment effect of reduced pain at 1-week follow-up for Phase I and at 4-week follow-up for Phase II. The overall level of pain was significantly lower for the active group, compared to sham, in Phase II. No significant changes were found for the PHQ-9 or SWLS at any time points. Results indicated that tDCS does seem to be a promising tool to manage pain in patients with SCI and repeated stimulation sessions are needed to induce long-lasting effects. Based on the study protocol, it appears that adding a second treatment period could induce long-lasting effects.

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