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Anodal transcranial direct current stimulation for chronic pain in the elderly: a pilot study

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Abstract

Background and aims

Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulatory technique that can affect human pain perception. The present open-label, single-arm study investigated whether primary motor cortex anodal tDCS treatment reduces chronic foot pain intensity and improves depression and pain-related anxiety symptoms in patients with chronic plantar fasciitis.

Methods

Ten patients with symptomatic treatment-resistant plantar fasciitis were enrolled in the study. The treatment consisted of anodal tDCS over the motor area of the leg contralateral to the symptomatic foot for 20 min, at 2 mA for 5 consecutive days. Pre-tDCS (T0), post-tDCS (T1), 1 week (T2), and 4 weeks (T3) post-treatment assessments were conducted consisting of the Visual Analog Scale for pain intensity, the Foot Function Index (FFI), the Pain Anxiety Symptom Scale (PASS-20), and the Hamilton Rating Scale for Depression (HDRS-17 items).

Results

Anodal tDCS treatment induced a significant improvement in pain intensity; FFI and PASS scores that were maintained up to 4 weeks post-treatment. In addition, patients reported taking fewer pain medication tablets following the treatments.

Discussion and conclusions

Our results indicate that anodal tDCS may be a viable treatment to control pain and psychological comorbidity in elderly patients with treatment-resistant foot pain.

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References

  1. Committee on Advancing Pain Research C, and Education, Institute of Medicine (2011) Relieving pain in America: a blueprint for transforming prevention, care, education, and research. The National Academies Press, Washington, DC

    Google Scholar 

  2. Shi Y, Hooten WM, Roberts RO et al (2010) Modifiable risk factors for incidence of pain in older adults. Pain 151(2):366–371

    Article  PubMed  Google Scholar 

  3. Dunn JE, Link CL, Felson DT et al (2004) Prevalence of foot and ankle conditions in a multiethnic community sample of older adults. Am J Epidemiol 159(5):491–498

    Article  CAS  PubMed  Google Scholar 

  4. Riddle DL, Pulisic M, Pidcoe P et al (2003) Risk factors for Plantar fasciitis: a matched case-control study. J Bone Joint Surg Am 85(5):872–877

    PubMed  Google Scholar 

  5. Riddle DL, Pulisic M, Sparrow K (2004) Impact of demographic and impairment-related variables on disability associated with plantar fasciitis. Foot Ankle Int 25(5):311–317

    PubMed  Google Scholar 

  6. Riddle DL, Schappert SM (2004) Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors. Foot Ankle Int 25(5):303–310

    PubMed  Google Scholar 

  7. Rosenbaum AJ, DiPreta JA, Misener D (2014) Plantar heel pain. Med Clin North Am 98(2):339–352

    Article  PubMed  Google Scholar 

  8. Smith MT, Edwards RR, Robinson RC et al (2004) Suicidal ideation, plans, and attempts in chronic pain patients: factors associated with increased risk. Pain 111(1–2):201–208

    Article  PubMed  Google Scholar 

  9. Stubbs B, Schofield P, Binnekade T et al (2014) Pain is associated with recurrent falls in community-dwelling older adults: evidence from a systematic review and meta-analysis. Pain Med 15(7):1115–1128

    Article  PubMed  Google Scholar 

  10. Tsubokawa T, Katayama Y, Yamamoto T et al (1993) Chronic motor cortex stimulation in patients with thalamic pain. J Neurosurg 78(3):393–401

    Article  CAS  PubMed  Google Scholar 

  11. Nuti C, Peyron R, Garcia-Larrea L et al (2005) Motor cortex stimulation for refractory neuropathic pain: 4 year outcome and predictors of efficacy. Pain 118(1–2):43–52

    Article  PubMed  Google Scholar 

  12. Lefaucheur JP, Drouot X, Keravel Y et al (2001) Pain relief induced by repetitive transcranial magnetic stimulation of precentral cortex. Neuroreport 12(13):2963–2965

    Article  CAS  PubMed  Google Scholar 

  13. Lefaucheur JP (2006) The use of repetitive transcranial magnetic stimulation (rTMS) in chronic neuropathic pain. Neurophysiol Clin 36(3):117–124

    Article  CAS  PubMed  Google Scholar 

  14. Coffey RJ (2001) Deep brain stimulation for chronic pain: results of two multicenter trials and a structured review. Pain Med 2(3):183–192

    Article  CAS  PubMed  Google Scholar 

  15. Fregni F, Boggio PS, Lima MC et al (2006) A sham-controlled, phase II trial of transcranial direct current stimulation for the treatment of central pain in traumatic spinal cord injury. Pain 122(1–2):197–209

    Article  PubMed  Google Scholar 

  16. Fregni F, Gimenes R, Valle AC et al (2006) A randomized, sham-controlled, proof of principle study of transcranial direct current stimulation for the treatment of pain in fibromyalgia. Arthritis Rheum 54(12):3988–3998

    Article  PubMed  Google Scholar 

  17. Paulus W (2003) Transcranial direct current stimulation (tDCS). Suppl Clin Neurophysiol 56:249–254

    Article  CAS  PubMed  Google Scholar 

  18. Priori A (2003) Brain polarization in humans: a reappraisal of an old tool for prolonged non-invasive modulation of brain excitability. Clin Neurophysiol 114(4):589–595

    Article  PubMed  Google Scholar 

  19. Nitsche MA, Seeber A, Frommann K et al (2005) Modulating parameters of excitability during and after transcranial direct current stimulation of the human motor cortex. J Physiol 568(Pt 1):291–303

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Liebetanz D, Nitsche MA, Tergau F et al (2002) Pharmacological approach to the mechanisms of transcranial DC-stimulation-induced after-effects of human motor cortex excitability. Brain 125(Pt 10):2238–2247

    Article  PubMed  Google Scholar 

  21. Valle A, Roizenblatt S, Botte S et al (2009) Efficacy of anodal transcranial direct current stimulation (tDCS) for the treatment of fibromyalgia: results of a randomized, sham-controlled longitudinal clinical trial. J Pain Manag 2(3):353–361

    PubMed  PubMed Central  Google Scholar 

  22. Mori F, Codeca C, Kusayanagi H et al (2009) Effects of anodal transcranial direct current stimulation on chronic neuropathic pain in patients with multiple sclerosis. J Pain 11(5):436–442

    Article  PubMed  Google Scholar 

  23. Soler MD, Kumru H, Pelayo R et al (2010) Effectiveness of transcranial direct current stimulation and visual illusion on neuropathic pain in spinal cord injury. Brain 133(9):2565–2577

    Article  PubMed  PubMed Central  Google Scholar 

  24. O’Connell NE, Cossar J, Marston L et al (2012) Transcranial direct current stimulation of the motor cortex in the treatment of chronic nonspecific low back pain: a randomized, double-blind exploratory study. Clin J Pain 29(1):26–34

    Article  Google Scholar 

  25. Dubois PE, Ossemann M, de Fays K et al (2013) Postoperative analgesic effect of transcranial direct current stimulation in lumbar spine surgery: a randomized control trial. Clin J Pain 29(8):696–701

    Article  PubMed  Google Scholar 

  26. Hagenacker T, Bude V, Naegel S et al (2014) Patient-conducted anodal transcranial direct current stimulation of the motor cortex alleviates pain in trigeminal neuralgia. J Headache Pain 15:78

    Article  PubMed  PubMed Central  Google Scholar 

  27. Borckardt JJ, Bikson M, Frohman H et al (2012) A pilot study of the tolerability and effects of high-definition transcranial direct current stimulation (HD-tDCS) on pain perception. J Pain 13(2):112–120

    Article  PubMed  Google Scholar 

  28. Price DD, McGrath PA, Rafii A et al (1983) The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 17(1):45–56

    Article  CAS  PubMed  Google Scholar 

  29. Budiman-Mak E, Conrad KJ, Roach KE (1991) The Foot Function Index: a measure of foot pain and disability. J Clin Epidemiol 44(6):561–570

    Article  CAS  PubMed  Google Scholar 

  30. McCracken LM, Dhingra L (2002) A short version of the Pain Anxiety Symptoms Scale (PASS-20): preliminary development and validity. Pain res Manag 7(1):45–50

    Article  PubMed  Google Scholar 

  31. Roelofs J, McCracken L, Peters ML et al (2004) Psychometric evaluation of the Pain Anxiety Symptoms Scale (PASS) in chronic pain patients. J Behav Med 27(2):167–183

    Article  PubMed  Google Scholar 

  32. Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 23:56–62

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Antal A, Terney D, Kuhnl S et al (2010) Anodal transcranial direct current stimulation of the motor cortex ameliorates chronic pain and reduces short intracortical inhibition. J Pain Symptom Manag 39(5):890–903

    Article  Google Scholar 

  34. Carroll D, Joint C, Maartens N et al (2000) Motor cortex stimulation for chronic neuropathic pain: a preliminary study of 10 cases. Pain 84(2–3):431–437

    Article  CAS  PubMed  Google Scholar 

  35. Shin HC, Chapin JK (1990) Mapping the effects of motor cortex stimulation on somatosensory relay neurons in the rat thalamus: direct responses and afferent modulation. Brain Res Bull 24(2):257–265

    Article  CAS  PubMed  Google Scholar 

  36. Mendonca ME, Santana MB, Baptista AF et al (2011) Transcranial DC stimulation in fibromyalgia: optimized cortical target supported by high-resolution computational models. J Pain 12(5):610–617

    Article  PubMed  Google Scholar 

  37. Lang N, Siebner HR, Ward NS et al (2005) How does transcranial DC stimulation of the primary motor cortex alter regional neuronal activity in the human brain? Eur J Neurosci 22(2):495–504

    Article  PubMed  PubMed Central  Google Scholar 

  38. Lima MC, Fregni F (2008) Motor cortex stimulation for chronic pain: systematic review and meta-analysis of the literature. Neurology 70(24):2329–2337

    Article  PubMed  Google Scholar 

  39. Leveille SG, Guralnik JM, Ferrucci L et al (1998) Foot pain and disability in older women. Am J Epidemiol 148(7):657–665

    Article  CAS  PubMed  Google Scholar 

  40. Shumway-Cook A, Brauer S, Woollacott M (2000) Predicting the probability for falls in community-dwelling older adults using the Timed Up and Go Test. Phys Ther 80(9):896–903

    CAS  PubMed  Google Scholar 

  41. Vestergaard P, Rejnmark L, Mosekilde L (2006) Fracture risk associated with the use of morphine and opiates. J Intern Med 260(1):76–87

    Article  CAS  PubMed  Google Scholar 

  42. Saunders KW, Dunn KM, Merrill JO et al (2010) Relationship of opioid use and dosage levels to fractures in older chronic pain patients. J Gen Intern Med 25(4):310–315

    Article  PubMed  PubMed Central  Google Scholar 

  43. Caes L, Fisher E, Clinch J et al (2014) The role of pain-related anxiety in adolescents’ disability and social impairment: ALSPAC data. Eur J Pain 19:842

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Funding for this research was provided by an NYCPM Student Independent Research grant.

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Author notes

    Authors and Affiliations

    1. Department of Interprofessional Health Sciences and Health Administration, School of Health and Medical Sciences, Seton Hall University, 400 South Orange Avenue, South Orange, NJ, 07079, USA

      Carmen Concerto & Fortunato Battaglia

    2. Department of Pre-Clinical Sciences, New York College of Podiatric Medicine, New York, NY, USA

      Mohomad Al Sawah, Eileen Chusid & Michael Trepal

    3. Department of Physical Therapy, New York College of Podiatric Medicine, New York, NY, USA

      Gregory Taylor

    4. Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy

      Eugenio Aguglia

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    1. Carmen Concerto
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    2. Mohomad Al Sawah
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    3. Eileen Chusid
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    4. Michael Trepal
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    5. Gregory Taylor
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    6. Eugenio Aguglia
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    7. Fortunato Battaglia
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    Correspondence to Fortunato Battaglia.

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    Conflict of interest

    All authors certify that they have not had any financial and personal relationships with other people or organizations that could inappropriately influence or bias this work. There is no conflict of interest for any of the authors.

    Ethical approval

    The protocol of the study was approved by the ethic committee of the New York College of Podiatric Medicine. All procedures were in accordance with the 1964 Declaration of Helsinki ethical standard and its later amendments.

    Informed consent

    Informed consent was obtained from all individual participants included in the study.

    Additional information

    C. Concerto and M. Al Sawah contributed equally to this work.

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    Concerto, C., Al Sawah, M., Chusid, E. et al. Anodal transcranial direct current stimulation for chronic pain in the elderly: a pilot study. Aging Clin Exp Res 28, 231–237 (2016). https://doi.org/10.1007/s40520-015-0409-1

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    • DOI: https://doi.org/10.1007/s40520-015-0409-1

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