Skip to main content
SpringerLink
Log in

Transkranielle Wechselstromstimulation zur Modulation von Oszillationen bei Schmerzerkrankungen

Transcranial alternating current stimulation to modulate oscillations in pain disorders

  • Schwerpunkt
  • Published:
Der Schmerz Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Chronische Schmerzen sind ein verbreitetes Gesundheitsproblem mit komplexer, herausfordernder Therapie. Techniken der nichtinvasiven Hirnstimulation, speziell der transkraniellen Wechselstromstimulation („transcranial alternating current stimulation“ [tACS]) stellen aufgrund wachsender Evidenz für die Assoziation veränderter neuronaler Oszillationen mit chronischen Schmerzen eine vielversprechende, nebenwirkungsarme neue Therapieform dar. Allerdings wurde die tACS bislang nur in wenigen Studien mit variabler Methodik auf eine mögliche Anwendbarkeit bei Patienten mit chronischen Schmerzen geprüft.

Ziel der Arbeit

Darstellung und Einordnung der bisherigen Evidenz, Evaluation eines potenziellen therapeutischen Nutzens für Patienten mit chronischem Schmerz.

Material und Methoden

Literaturrecherche in den Datenbanken MEDLINE, Embase, Cochrane Library und Google Scholar.

Ergebnisse

Bislang wurde die tACS zur Therapie chronischer Schmerzen nur in 3 Studien mit sehr unterschiedlicher methodischer Herangehensweise und Qualität untersucht.

Schlussfolgerung

Aktuell bieten diese Daten keine ausreichende Evidenz für eine therapeutische Nutzung der tACS zur Therapie chronischer Schmerzen. Zukünftige Studien können die Frage nach einem therapeutischen Nutzen der tACS für diese Indikation adressieren. Dabei sollten bestehende Empfehlungen zur Konzeption und Durchführung von tACS-Studien berücksichtigt und verbesserte Stimulationstechniken angewendet werden.

Abstract

Background

Chronic pain is a common health problem, for which the treatment is complex and challenging. Non-invasive brain stimulation techniques, specifically transcranial alternating current stimulation (tACS), show promise as a well-tolerated new therapeutic modality with few side effects. This is supported by growing evidence of an association between altered neuronal oscillations and chronic pain. However, to date, only a handful of studies with variable methodology have evaluated tACS for potential applicability to patients with chronic pain.

Objectives

Presentation and discussion of the evidence thus far, evaluation of a potential therapeutic benefit for chronic pain patients.

Materials and Methods

Literature search in MEDLINE, Embase, Cochrane Library, and Google Scholar databases.

Results

To date, tACS for chronic pain therapy has been investigated in only three studies with very different methodological approaches and quality.

Discussion

These data currently do not provide sufficient evidence for the therapeutic use of tACS for chronic pain therapy. Future studies may address the question of a therapeutic benefit of tACS for this indication utilizing improved stimulation techniques and considering existing recommendations for the design and conduct of tACS studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Ahn S, Prim JH, Alexander ML, McCulloch KL, Fröhlich F (2019) Identifying and engaging neuronal oscillations by transcranial alternating current stimulation in patients with chronic low back pain: a randomized, crossover, double-blind, sham-controlled pilot study. J Pain 20(3):277.e1

    Article  PubMed  Google Scholar 

  2. Antal A, Alekseichuk I, Bikson M et al (2017) Low intensity transcranial electric stimulation: safety, ethical, legal regulatory and application guidelines. Clin Neurophysiol 128(9):1774–1809

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Antal A, Bischoff R, Stephani C, Czesnik D, Klinker F, Timäus C, Paulus W (2020) Low intensity, transcranial, alternating current stimulation reduces migraine attack burden in a home application set-up: a double-blinded, randomized feasibility study. Brain Sci 10(11):888

    Article  PubMed  PubMed Central  Google Scholar 

  4. Antal A, Boros K, Poreisz C, Chaieb L, Terney D, Paulus W (2008) Comparatively weak after-effects of transcranial alternating current stimulation (tACS) on cortical excitability in humans. Brain Stimul 1(2):97–105

    Article  PubMed  Google Scholar 

  5. Antal A, Herrmann CS (2016) Transcranial alternating current and random noise stimulation: possible mechanisms. Neural Plast 2016:3616807

    Article  PubMed  PubMed Central  Google Scholar 

  6. Bernardi L, Bertuccelli M, Formaggio E, Rubega M, Bosco G, Tenconi E, Cattelan M, Masiero S, Del Felice A (2021) Beyond physiotherapy and pharmacological treatment for fibromyalgia syndrome: tailored tACS as a new therapeutic tool. Eur Arch Psychiatry Clin Neurosci 271(1):199–210

    Article  PubMed  Google Scholar 

  7. Bikson M, Grossman P, Thomas C et al (2016) Safety of transcranial direct current stimulation: evidence based update 2016. Brain Stimul 9(5):641–661

    Article  PubMed  PubMed Central  Google Scholar 

  8. Bjørk MH, Stovner LJ, Engstrøm M, Stjern M, Hagen K, Sand T (2009) Interictal quantitative EEG in migraine: a blinded controlled study. J Headache Pain 10(5):331–339

    Article  PubMed  PubMed Central  Google Scholar 

  9. Chou R, Turner JA, Devine EB et al (2015) The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a national institutes of health pathways to prevention workshop. Ann Intern Med 162(4):276–286

    Article  PubMed  Google Scholar 

  10. Cohen SP, Vase L, Hooten WM (2021) Chronic pain: an update on burden, best practices, and new advances. Lancet 397(10289):2082–2097

    Article  PubMed  Google Scholar 

  11. Dissanayaka TD, Zoghi M, Farrell M, Egan GF, Jaberzadeh S (2018) Sham transcranial electrical stimulation and its effects on corticospinal excitability: a systematic review and meta-analysis. Rev Neurosci 29(2):223–232

    Article  PubMed  Google Scholar 

  12. Elyamany O, Leicht G, Herrmann CS, Mulert C (2021) Transcranial alternating current stimulation (tACS): from basic mechanisms towards first applications in psychiatry. Eur Arch Psychiatry Clin Neurosci 271(1):135–156

    Article  PubMed  Google Scholar 

  13. Fallon N, Chiu Y, Nurmikko T, Stancak A (2018) Altered theta oscillations in resting EEG of fibromyalgia syndrome patients. Eur J Pain 22(1):49–57

    Article  CAS  PubMed  Google Scholar 

  14. Fregni F, Freedman S, Pascual-Leone A (2007) Recent advances in the treatment of chronic pain with non-invasive brain stimulation techniques. Lancet Neurol 6(2):188–191

    Article  PubMed  Google Scholar 

  15. Frohlich F, Riddle J (2021) Conducting double-blind placebo-controlled clinical trials of transcranial alternating current stimulation (tACS). Transl Psychiatry 11(1):284

    Article  PubMed  PubMed Central  Google Scholar 

  16. Haberbosch L, Schmidt S, Jooss A, Köhn A, Kozarzewski L, Rönnefarth M et al (2019) Rebound or entrainment? The influence of alternating current stimulation on individual alpha. Front Hum Neurosci 13:43

    Article  PubMed  PubMed Central  Google Scholar 

  17. Haberbosch L, Datta A, Thomas C, Jooß A, Köhn A, Rönnefarth M, Scholz M, Brandt SA, Schmidt S (2019) Safety aspects, tolerability and modeling of retinofugal alternating current stimulation. Front Neurosci 13:783

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hohn VD, May ES, Ploner M (2019) From correlation towards causality: modulating brain rhythms of pain using transcranial alternating current stimulation. Pain Rep 4(4):e723

    Article  PubMed  PubMed Central  Google Scholar 

  19. Horvath JC, Forte JD, Carter O (2015) Evidence that transcranial direct current stimulation (tDCS) generates little-to-no reliable neurophysiologic effect beyond MEP amplitude modulation in healthy human subjects: a systematic review. Neuropsychologia 66:213–236

    Article  PubMed  Google Scholar 

  20. Kandić M, Moliadze V, Andoh J, Flor H, Nees F (2021) Brain circuits involved in the development of chronic musculoskeletal pain: evidence from non-invasive brain stimulation. Front Neurol 12:732034

    Article  PubMed  PubMed Central  Google Scholar 

  21. Lim M, Kim JS, Kim DJ, Chung CK (2016) Increased low- and high-frequency oscillatory activity in the prefrontal cortex of fibromyalgia patients. Front Hum Neurosci 10:111

    Article  PubMed  PubMed Central  Google Scholar 

  22. May ES, Nickel MM, Dinh TS, Tiemann L, Heitmann H, Voth I, Tölle TR, Gross J, Ploner M (2019) Prefrontal gamma oscillations reflect ongoing pain intensity in chronic back pain patients. Hum Brain Mapp 40(1):293–305

    Article  PubMed  Google Scholar 

  23. Mekhail N, Visnjevac O, Azer G, Mehanny DS, Agrawal P, Foorsov V (2018) Spinal cord stimulation 50 years later: clinical outcomes of spinal cord stimulation based on randomized clinical trials—a systematic review. Reg Anesth Pain Med 43(4):391–406

    Article  PubMed  Google Scholar 

  24. Ploner M, Gross J, Timmermann L, Pollok B, Schnitzler A (2006) Pain suppresses spontaneous brain rhythms. Cereb Cortex 16(4):537–540

    Article  PubMed  Google Scholar 

  25. Ploner M, Sorg C, Gross J (2017) Brain rhythms of pain. Trends Cogn Sci 21(2):100–110

    Article  PubMed  PubMed Central  Google Scholar 

  26. Polanía R, Nitsche MA, Ruff CC (2018) Studying and modifying brain function with non-invasive brain stimulation. Nat Neurosci 21:174–187

    Article  PubMed  Google Scholar 

  27. Prim JH, Ahn S, Davila MI, Alexander ML, McCulloch KL, Frohlich F (2019) Targeting the autonomic nervous system balance in patients with chronic low back pain using transcranial alternating current stimulation: a randomized, crossover, double-blind, placebo-controlled pilot study. J Pain Res 12:3265–3277

    Article  PubMed  PubMed Central  Google Scholar 

  28. Reinhart RM (2022) Synchronizing neural rhythms. Science 377(6606):588–589

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Rios LP, Ye C, Thabane L (2010) Association between framing of the research question using the PICOT format and reporting quality of randomized controlled trials. BMC Med Res Methodol 10(1):1–8

    Article  PubMed  PubMed Central  Google Scholar 

  30. Sarnthein J, Stern J, Aufenberg C, Rousson V, Jeanmonod D (2006) Increased EEG power and slowed dominant frequency in patients with neurogenic pain. Brain 129(1):55–64

    Article  PubMed  Google Scholar 

  31. Schmidt S, Naranjo JR, Brenneisen C, Gundlach J, Schultz C, Kaube H, Hinterberger T, Jeanmonod D (2012) Pain ratings, psychological functioning and quantitative EEG in a controlled study of chronic back pain patients. PLoS One 7(3):e31138

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Schutter DJ (2016) Cutaneous retinal activation and neural entrainment in transcranial alternating current stimulation: a systematic review. Neuroimage 140:83–88

    Article  PubMed  Google Scholar 

  33. Woods AJ, Antal A, Bikson M, Boggio PS, Brunoni AR, Celnik P, Cohen LG, Fregni F, Herrmann CS, Kappenman ES, Knotkova H, Liebetanz D, Miniussi C, Miranda PC, Paulus W, Priori A, Reato D, Stagg C, Wenderoth N, Nitsche MA (2016) A technical guide to tDCS, and related non-invasive brain stimulation tools. Clin Neurophysiol 127(2):1031–1048

    Article  CAS  PubMed  Google Scholar 

  34. Wu L, Liu T, Wang J (2021) Improving the effect of transcranial alternating current stimulation (tACS): a systematic review. Front Hum Neurosci 15:652393. https://doi.org/10.3389/fnhum.2021.652393

    Article  PubMed  PubMed Central  Google Scholar 

  35. Yang S, Chang MC (2020) Effect of repetitive transcranial magnetic stimulation on pain management: a systematic narrative review. Front Neurol 11:114

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Charité Mitte und Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin, Gliedkörperschaft der Freien Universität Berlin, der Humboldt Universität zu Berlin und des Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Deutschland

    Jan D. Wandrey

  2. Institut für Neuropsychologie und Klinische Psychologie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland

    Mina Kandić & Angela Serian M.Sc. Psychologie

  3. Klinik für Endokrinologie, Diabetologie und Stoffwechselmedizin, Charité – Universitätsmedizin Berlin, Gliedkörperschaft der Freien Universität Berlin, der Humboldt Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Deutschland

    Linus Haberbosch

  4. BIH Biomedical Innovation Academy, BIH Charité Junior Digital Clinician Scientist Program, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland

    Linus Haberbosch

Authors
  1. Jan D. Wandrey
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mina Kandić
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Linus Haberbosch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Angela Serian M.Sc. Psychologie
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Angela Serian M.Sc. Psychologie.

Ethics declarations

Interessenkonflikt

J.D. Wandrey, M. Kandić, L. Haberbosch und A. Serian geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Die Autoren Jan D. Wandrey, Mina Kandić, Linus Haberbosch und Angela Serian haben zu gleichen Teilen zum Manuskript beigetragen.

figure qr

QR-Code scannen & Beitrag online lesen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wandrey, J.D., Kandić, M., Haberbosch, L. et al. Transkranielle Wechselstromstimulation zur Modulation von Oszillationen bei Schmerzerkrankungen. Schmerz 37, 281–289 (2023). https://doi.org/10.1007/s00482-022-00684-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00482-022-00684-4

Schlüsselwörter

Keywords

Search

Navigation