posted February 06, 2017 12:16 PM            

Transcranial direct current stimulation (TdCS) clinical trials have exploded in recent years. This intervention was once reserved to the laboratory setting, or perhaps for military training purposes. Now it is widely available to the consumer and can even be made DIY with a quick trip to the hardware store.

The weak electrical currents from the equivalent of a 9V battery are administered to the scalp in various regions. They exert local effects on the underlying cortex, but also on functionally connected remote regions. Certain areas have been implicated for neuro-stimulation of learning, pain control, and anxiety, among others (1).

First developed for stroke rehabilitation and other types of brain trauma, recent TdCS studies have examined its effect on chronic pain, treatment resistant depression, cerebral palsy, schizophrenia, and eating disorders (1).

RESEARCH IN FIBROMYALGIA

Transcranial direct current stimulation (TdCS) has been shown to improve pain symptoms in fibromyalgia in various blinded, clinical trials. The exact mechanisms are still unknown but it is believed to stimulate the release of the inhibitory neurotransmitter GABA and influence other neurotransmitters. Other studies have shown sleep improvements following TdCS, including more frequent REM cycles and longer duration of sleep (2).

RISK VS BENEFITS

The exact mechanisms in which TdCS effects the brain is mostly unknown. The research is mixed as to whether it increases neuronal plasticity through growth factors such as BDNF. There is also little known about the “proper” application and duration of treatment (3).

Some studies have shown positive effects on learning and memory only when the stimulation occurs while doing a task. No follow-up studies are available to determine the long term or lasting effects of TdCS. Some TdCS users experience mild side effects such as headache, skin irritation under the electrodes, or over stimulation (3). However, it has been noted that TdCS use gives considerably fewer side effects compared to FDA approved fibromyalgia drugs (4).

HOW ABOUT TDCS FOR THE ME/CFS BRAIN?

Studies using fMRI and other advanced brain imaging techniques demonstrated increased cerebral blood flow during TdCS. This is thought to be due to stimulation of glial cells in the brain—specifically astrocytes which regulate much of cerebral blood flow (5). Similar advanced imaging studies have demonstrated widespread hypoperfusion (decreased blood flow) to the brain in ME/CFS patients (6). Neuro-stimulation with TdCS may be a viable intervention to improve cerebral blood flow in some patients, with the potential to reduce cognitive symptoms.

1 Foerster BR, et al (2014) Excitatory and Inhibitory Brain Metabolites as Targets and Predictors of Effective Motor Cortex tDCS Therapy in Fibromyalgia. Arthritis Rheumatol. http://www.ncbi.nlm.nih.gov/pubmed/25371383

2 Roizenblatt S, et al. (2007) Site-specific effects of transcranial direct current stimulation on sleep and pain in fibromyalgia: a randomized, sham-controlled study. Pain Pract. 7(4):297-306. Epub 2007 Nov 6. http://www.ncbi.nlm.nih.gov/pubmed/17986164

3 Berryhill ME, etl al (2014) Hits and misses: leveraging tDCS to advance cognitive research. Front Psychol. 5:800. http://www.ncbi.nlm.nih.gov/pubmed/25120513

4 Marlow NM, Bonilha HS, Short EB. (2013) Efficacy of transcranial direct current stimulation and repetitive transcranial magnetic stimulation for treating fibromyalgia syndrome: a systematic review. Pain Pract. 13(2):131-45. http://www.ncbi.nlm.nih.gov/pubmed/22631436

5 Nord CL, Lally N, Charpentier CJ (2013) Harnessing electric potential: DLPFC tDCS induces widespread brain perfusion changes. Front Syst Neurosci. 7:99. http://www.ncbi.nlm.nih.gov/pubmed/24348348

6 Yoshiuchi K, Farkas J, Natelson BH. (2006) Patients with chronic fatigue syndrome have reduced absolute cortical blood flow. Clin Physiol Funct Imaging. 26(2):83-6. http://www.ncbi.nlm.nih.gov/pubmed/16494597

posted February 08, 2017 06:14 PM            

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Originally posted by Lexxigramer:
Medicare and Medicaid do not cover it.

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Hmm.. there are some safe and quality tDCS devices at amazon.com under 150$ check the top products and make sure to read verified purchase reviews before deciding which device to buy.

posted February 08, 2017 06:57 PM            

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Summary

Transcranial direct current stimulation (tDCS) is an established technique to modulate cortical excitability1,2. It has been used as an investigative tool in neuroscience due to its effects on cortical plasticity, easy operation, and safe profile. One area that tDCS has been showing encouraging results is pain alleviation3-5.

Abstract

Transcranial direct current stimulation (tDCS) is a technique that has been intensively investigated in the past decade as this method offers a non-invasive and safe alternative to change cortical excitability2. The effects of one session of tDCS can last for several minutes, and its effects depend on polarity of stimulation, such as that cathodal stimulation induces a decrease in cortical excitability, and anodal stimulation induces an increase in cortical excitability that may last beyond the duration of stimulation6. These effects have been explored in cognitive neuroscience and also clinically in a variety of neuropsychiatric disorders – especially when applied over several consecutive sessions4. One area that has been attracting attention of neuroscientists and clinicians is the use of tDCS for modulation of pain-related neural networks3,5. Modulation of two main cortical areas in pain research has been explored: primary motor cortex and dorsolateral prefrontal cortex7. Due to the critical role of electrode montage, in this article, we show different alternatives for electrode placement for tDCS clinical trials on pain; discussing advantages and disadvantages of each method of stimulation.

Rationale for using tDCS in chronic pain:

The fact that multiple therapeutic pharmacological modalities provide only modest relief for chronic pain patients raises the possibility that the cause for the persistence of this debilitating disorder may lie within plastic changes in pain related neural networks. Interestingly, modulation of cortical activity can be achieved non-invasively by tDCS, as described earlier, which has been reported to produce lasting therapeutic effects in chronic pain due to changes in cortical plasticity.

Clinical effect of tDCS in chronic pain:

It has been shown that tDCS applied to the motor cortex changes the local cortical excitability (Figure 6)6. More precisely, anodal stimulation results in an increase of neuronal excitability, whereas cathodal stimulation has opposite results6. Indeed, anodal tDCS application over M1 leads to a greater improvement in visual analogue scale (VAS) pain ratings than sham tDCS. This therapeutic effect on pain following M1 stimulation, although transient, was reproduced in several groups of patients with neuropathic pain syndromes like trigeminal neuralgia, poststroke pain syndrome31, back pain and fibromyalgia32. Interestingly, clinical trials in neuropathic pain, due to spinal cord injury, stimulation of the motor cortex by tDCS showed pain improvement and cumulative analgesic effect that lasted two weeks after the stimulation. There is also evidence of its analgesic effect in fibromyalgia patients33 that is still significant after three weeks of follow-up for anodal tDCS of the M1 compared with sham stimulation, and as well as stimulation of the DLPFC33. Although the effects of anodal tDCS over DLFPC for pain improvement have not been explored extensively, it was shown it can be used to modulate pain thresholds in healthy subjects34. Nevertheless, stimulation of this brain area is a reliable technique for enhancing working memory 10, increasing performance on memory tasks in Alzheimer disease9 and reducing cue-provoked smoking craving significantly35 for instance; therefore it is also conceivable that this might be a useful strategy to modulate affective-emotional cognitive networks associated with pain processing in patients with chronic pain.

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