At-Home Cortical Stimulation for Neuropathic Pain: a Feasibility Study with Initial Clinical Results
The clinical use of noninvasive cortical stimulation procedures is hampered by the limited duration of the analgesic effects and the need to perform stimulation in hospital settings. Here, we tested the feasibility and pilot efficacy of an internet-based system for at-home, long-duration, medically controlled transcranial motor cortex stimulation (H-tDCS), via a double-blinded, sham-controlled trial in patients with neuropathic pain refractory to standard-of-care drug therapy. Each patient was first trained at hospital, received a stimulation kit, allotted a password-protected Web space, and completed daily tDCS sessions during 5 weeks, via a Bluetooth connection between stimulator and a minilaptop. Each session was validated and internet-controlled by hospital personnel. Daily pain ratings were obtained during 11 consecutive weeks, and afterwards via iterative visits/phone contacts. Twenty full procedures were completed in 12 consecutive patients (500 daily tDCS sessions, including 20% sham). No serious adverse effects were recorded. Superficial burning at electrode position occurred in 2 patients, and nausea/headache in two others, all of whom wished to pursue stimulation. Six out of the 12 patients achieved satisfactory relief on a scale combining pain scores, drug intake, and quality of life. Daily pain reports correlated with such combined assessment, and differentiated responders from nonresponders without overlap. Clinical improvement in responders could last up to 6 months. Five patients asked to repeat the whole procedure when pain resumed again, with comparable results. At-home, long-duration tDCS proved safe and technically feasible, and provided long-lasting relief in 50% of a small sample of patients with drug-resistant neuropathic pain.
KeywordsCortical stimulation Neuropathic pain tDCS Home stimulation rTMS
This work was supported by the APICIL Foundation for pain relief (grant reference 955.16), the Laboratory of Excellence (LABEX) CORTEX (grant numbers ANR-11-LABX-0042; ANR-11-IDEX-0007), and the French Society for Pain Evaluation and Therapy (Translational Research Grant 2012–14). We are grateful to the Neuroelectrics® team, in particular Giulio Ruffini, Antoine Ramis, and Guillem Mitjà, who helped us with technical aspects at the beginning of the project.
Compliance with Ethical Standards
Conflict of Interest
We declare that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. Luis Garcia-Larrea was scientific advisor of Neuroelectrics between 2013 and 2015.
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