Long-term analgesic effect of trans-spinal direct current stimulation compared to non-invasive motor cortex stimulation in complex regional pain syndrome

Hasan Hodaj; Jean-Francois Payen; Enkelejda Hodaj; Marc Sorel; Anne Dumolard; Laurent Vercueil; Chantal Delon-Martin; Jean-Pascal Lefaucheur

doi:10.1093/braincomms/fcad191

Long-term analgesic effect of trans-spinal direct current stimulation compared to non-invasive motor cortex stimulation in complex regional pain syndrome

Brain Commun. 2023 Jul 1;5(4):fcad191. doi: 10.1093/braincomms/fcad191. eCollection 2023.

Authors

Hasan Hodaj^{1

2}, Jean-Francois Payen^{1

2}, Enkelejda Hodaj³, Marc Sorel^{4

5}, Anne Dumolard¹, Laurent Vercueil⁶, Chantal Delon-Martin², Jean-Pascal Lefaucheur^{5

7}

Affiliations

¹ Centre de la Douleur, Pôle Anesthésie Réanimation, CHU Grenoble Alpes, 38000 Grenoble, France.
² Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France.
³ Centre d'Investigation Clinique, CHU Grenoble Alpes, 38000, Grenoble, France.
⁴ Centre d'Evaluation et de Traitement de la Douleur, Hôpital Sud-Seine-et-Marne, site Nemours, Nemours, France.
⁵ EA 4391, Excitabilité Nerveuse et Thérapeutique, Faculté de Santé, Univ. Paris Est Créteil, Créteil, France.
⁶ Service de Neurologie, CHU Grenoble Alpes, 38000, Grenoble, France.
⁷ Unité de Neurophysiologie Clinique, Service de Physiologie-Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France.

Abstract

The aim of the present study was to compare the analgesic effect of motor cortex stimulation using high-frequency repetitive transcranial magnetic stimulation or transcranial direct current stimulation and transcutaneous spinal direct current stimulation in patients with complex regional pain syndrome. Thirty-three patients with complex regional pain syndrome were randomized to one of the three treatment groups (repetitive transcranial magnetic stimulation, n = 11; transcranial direct current stimulation, n = 10; transcutaneous spinal direct current stimulation, n = 12) and received a series of 12 sessions of stimulation for 3 weeks (induction phase) and 11 sessions for 4 months (maintenance therapy). The primary end-point was the mean pain intensity assessed weekly with a visual numerical scale during the month prior to treatment (baseline), the 5-month stimulation period and 1 month after the treatment. The weekly visual numerical scale pain score was significantly reduced at all time points compared to baseline in the transcutaneous spinal direct current stimulation group, at the last two time points in the repetitive transcranial magnetic stimulation group (end of the 5-month stimulation period and 1 month later), but at no time point in the transcranial direct current stimulation group. A significant pain relief was observed at the end of induction phase using transcutaneous spinal direct current stimulation compared to repetitive transcranial magnetic stimulation (P = 0.008) and to transcranial direct current stimulation (P = 0.003). In this trial, transcutaneous spinal direct current stimulation was more efficient to relieve pain in patients with complex regional pain syndrome compared to motor cortex stimulation techniques (repetitive transcranial magnetic stimulation, transcranial direct current stimulation). This efficacy was found during the induction phase and was maintained thereafter. This study warrants further investigation to confirm the potentiality of transcutaneous spinal direct current stimulation as a therapeutic option in complex regional pain syndrome.

Keywords: CRPS; chronic pain; rTMS; tDCS; tsDCS.