The Effects of Transcutaneous Spinal Direct Current Stimulation on Neuropathic Pain in Multiple Sclerosis: Clinical and Neurophysiological Assessment
Background: Central neuropathic pain represents one of the most common symptoms in multiple sclerosis (MS) and it seriously affects quality of life. Spinal mechanisms may contribute to the pathogenesis of neuropathic pain in MS. Converging evidence from animal models and neurophysiological and clini...
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Frontiers Media S.A.
2019-02-01
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Series: | Frontiers in Human Neuroscience |
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Online Access: | https://www.frontiersin.org/article/10.3389/fnhum.2019.00031/full |
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Article |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Eliana Berra Roberto Bergamaschi Roberto Bergamaschi Roberto De Icco Roberto De Icco Carlotta Dagna Armando Perrotta Marco Rovaris Maria Grazia Grasso Maria G. Anastasio Giovanna Pinardi Federico Martello Stefano Tamburin Giorgio Sandrini Giorgio Sandrini Cristina Tassorelli Cristina Tassorelli |
spellingShingle |
Eliana Berra Roberto Bergamaschi Roberto Bergamaschi Roberto De Icco Roberto De Icco Carlotta Dagna Armando Perrotta Marco Rovaris Maria Grazia Grasso Maria G. Anastasio Giovanna Pinardi Federico Martello Stefano Tamburin Giorgio Sandrini Giorgio Sandrini Cristina Tassorelli Cristina Tassorelli The Effects of Transcutaneous Spinal Direct Current Stimulation on Neuropathic Pain in Multiple Sclerosis: Clinical and Neurophysiological Assessment Frontiers in Human Neuroscience neuropathic pain transcutaneous spinal direct current stimulation (ts-DCS) non-invasive nociceptive withdrawal reflex neuromodulation multiple sclerosis |
author_facet |
Eliana Berra Roberto Bergamaschi Roberto Bergamaschi Roberto De Icco Roberto De Icco Carlotta Dagna Armando Perrotta Marco Rovaris Maria Grazia Grasso Maria G. Anastasio Giovanna Pinardi Federico Martello Stefano Tamburin Giorgio Sandrini Giorgio Sandrini Cristina Tassorelli Cristina Tassorelli |
author_sort |
Eliana Berra |
title |
The Effects of Transcutaneous Spinal Direct Current Stimulation on Neuropathic Pain in Multiple Sclerosis: Clinical and Neurophysiological Assessment |
title_short |
The Effects of Transcutaneous Spinal Direct Current Stimulation on Neuropathic Pain in Multiple Sclerosis: Clinical and Neurophysiological Assessment |
title_full |
The Effects of Transcutaneous Spinal Direct Current Stimulation on Neuropathic Pain in Multiple Sclerosis: Clinical and Neurophysiological Assessment |
title_fullStr |
The Effects of Transcutaneous Spinal Direct Current Stimulation on Neuropathic Pain in Multiple Sclerosis: Clinical and Neurophysiological Assessment |
title_full_unstemmed |
The Effects of Transcutaneous Spinal Direct Current Stimulation on Neuropathic Pain in Multiple Sclerosis: Clinical and Neurophysiological Assessment |
title_sort |
effects of transcutaneous spinal direct current stimulation on neuropathic pain in multiple sclerosis: clinical and neurophysiological assessment |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Human Neuroscience |
issn |
1662-5161 |
publishDate |
2019-02-01 |
description |
Background: Central neuropathic pain represents one of the most common symptoms in multiple sclerosis (MS) and it seriously affects quality of life. Spinal mechanisms may contribute to the pathogenesis of neuropathic pain in MS. Converging evidence from animal models and neurophysiological and clinical studies in humans suggests a potential effect of transcranial direct current stimulation (tc-DCS) on neuropathic pain. Spinal application of DCS, i.e., transcutaneous spinal DCS (ts-DCS), may modulate nociception through inhibition of spinal reflexes. Therefore, ts-DCS could represents an effective, safe and well-tolerated treatment for neuropathic pain in MS, a largely unexplored topic. This study is a pilot randomized double-blind sham-controlled trial to evaluate the efficacy of ts-DCS on central neuropathic pain in MS patients.Methods: Thirty-three MS patients with central neuropathic pain were enrolled and randomly assigned to two groups in a double-blind sham-controlled design: anodal ts-DCS group (n = 19, 10 daily 20-min sessions, 2 mA) or sham ts-DCS group (n = 14, 10 daily 20-min sessions, 0 mA). The following clinical outcomes were evaluated before ts-DCS treatment (T0), after 10 days of treatment (T1) and 1 month after the end of treatment (T2): neuropathic pain symptoms inventory (NPSI), Ashworth Scale (AS) for spasticity and Fatigue Severity Scale (FSS). A subgroup of patients treated with anodal ts-DCS (n = 12) and sham ts-DCS (n = 11) also underwent a parallel neurophysiological study of the nociceptive withdrawal reflex (NWR) and the NWR temporal summation threshold (TST), two objective markers of pain processing at spinal level.Results: Anodal ts-DCS group showed a significant improvement in NPSI at T1, which persisted at T2, while we did not detect any significant change in AS and FSS. Sham ts-DCS group did not show any significant change in clinical scales. We observed a non-significant trend towards an inhibition of NWR responses in the anodal ts-DCS group at T1 and T2 when compared to baseline.Conclusions: Anodal ts-DCS seems to have an early and persisting (i.e., 1 month after treatment) clinical efficacy on central neuropathic pain in MS patients, probably through modulation of spinal nociception.Clinical Trial Registration:www.ClinicalTrials.gov, identifier #NCT02331654. |
topic |
neuropathic pain transcutaneous spinal direct current stimulation (ts-DCS) non-invasive nociceptive withdrawal reflex neuromodulation multiple sclerosis |
url |
https://www.frontiersin.org/article/10.3389/fnhum.2019.00031/full |
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doaj-2d1c8a8482284743ac5758fc3e5fbed12020-11-25T02:49:27ZengFrontiers Media S.A.Frontiers in Human Neuroscience1662-51612019-02-011310.3389/fnhum.2019.00031421502The Effects of Transcutaneous Spinal Direct Current Stimulation on Neuropathic Pain in Multiple Sclerosis: Clinical and Neurophysiological AssessmentEliana Berra0Roberto Bergamaschi1Roberto Bergamaschi2Roberto De Icco3Roberto De Icco4Carlotta Dagna5Armando Perrotta6Marco Rovaris7Maria Grazia Grasso8Maria G. Anastasio9Giovanna Pinardi10Federico Martello11Stefano Tamburin12Giorgio Sandrini13Giorgio Sandrini14Cristina Tassorelli15Cristina Tassorelli16Neurorehabilitation Unit, Department of Neurology, IRCCS C. Mondino Foundation, Pavia, ItalyNeurorehabilitation Unit, Department of Neurology, IRCCS C. Mondino Foundation, Pavia, ItalyMultiple Sclerosis Center, IRCCS C. Mondino Foundation, Pavia, ItalyNeurorehabilitation Unit, Department of Neurology, IRCCS C. Mondino Foundation, Pavia, ItalyDepartment of Brain and Behavioral Sciences, University of Pavia, Pavia, ItalyDepartment of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, ItalyIRCCS Neuromed, Pozzilli, ItalyNeurorehabilitation Unit and Multiple Sclerosis Center, IRCCS Santa Maria Nascente, Don Carlo Gnocchi Foundation, Milan, ItalyMultiple Sclerosis Unit, Rehabilitation Hospital Santa Lucia Foundation, Rome, ItalyIRCCS Neuromed, Pozzilli, ItalyNeurorehabilitation Unit and Multiple Sclerosis Center, IRCCS Santa Maria Nascente, Don Carlo Gnocchi Foundation, Milan, ItalyMultiple Sclerosis Unit, Rehabilitation Hospital Santa Lucia Foundation, Rome, ItalyDepartment of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, ItalyNeurorehabilitation Unit, Department of Neurology, IRCCS C. Mondino Foundation, Pavia, ItalyDepartment of Brain and Behavioral Sciences, University of Pavia, Pavia, ItalyNeurorehabilitation Unit, Department of Neurology, IRCCS C. Mondino Foundation, Pavia, ItalyDepartment of Brain and Behavioral Sciences, University of Pavia, Pavia, ItalyBackground: Central neuropathic pain represents one of the most common symptoms in multiple sclerosis (MS) and it seriously affects quality of life. Spinal mechanisms may contribute to the pathogenesis of neuropathic pain in MS. Converging evidence from animal models and neurophysiological and clinical studies in humans suggests a potential effect of transcranial direct current stimulation (tc-DCS) on neuropathic pain. Spinal application of DCS, i.e., transcutaneous spinal DCS (ts-DCS), may modulate nociception through inhibition of spinal reflexes. Therefore, ts-DCS could represents an effective, safe and well-tolerated treatment for neuropathic pain in MS, a largely unexplored topic. This study is a pilot randomized double-blind sham-controlled trial to evaluate the efficacy of ts-DCS on central neuropathic pain in MS patients.Methods: Thirty-three MS patients with central neuropathic pain were enrolled and randomly assigned to two groups in a double-blind sham-controlled design: anodal ts-DCS group (n = 19, 10 daily 20-min sessions, 2 mA) or sham ts-DCS group (n = 14, 10 daily 20-min sessions, 0 mA). The following clinical outcomes were evaluated before ts-DCS treatment (T0), after 10 days of treatment (T1) and 1 month after the end of treatment (T2): neuropathic pain symptoms inventory (NPSI), Ashworth Scale (AS) for spasticity and Fatigue Severity Scale (FSS). A subgroup of patients treated with anodal ts-DCS (n = 12) and sham ts-DCS (n = 11) also underwent a parallel neurophysiological study of the nociceptive withdrawal reflex (NWR) and the NWR temporal summation threshold (TST), two objective markers of pain processing at spinal level.Results: Anodal ts-DCS group showed a significant improvement in NPSI at T1, which persisted at T2, while we did not detect any significant change in AS and FSS. Sham ts-DCS group did not show any significant change in clinical scales. We observed a non-significant trend towards an inhibition of NWR responses in the anodal ts-DCS group at T1 and T2 when compared to baseline.Conclusions: Anodal ts-DCS seems to have an early and persisting (i.e., 1 month after treatment) clinical efficacy on central neuropathic pain in MS patients, probably through modulation of spinal nociception.Clinical Trial Registration:www.ClinicalTrials.gov, identifier #NCT02331654.https://www.frontiersin.org/article/10.3389/fnhum.2019.00031/fullneuropathic paintranscutaneous spinal direct current stimulation (ts-DCS)non-invasivenociceptive withdrawal reflexneuromodulationmultiple sclerosis |