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The effects of transcranial direct current stimulation with visual illusion in neuropathic pain due to spinal cord injury: An evoked potentials and quantitative thermal testing study

2012; Wiley; Volume: 17; Issue: 1 Linguagem: Inglês

10.1002/j.1532-2149.2012.00167.x

1532-2149

Hatice Kumru, María Soler, Joan Vidal, Xavier Navarro, Josep M. Tormos, Álvaro Pascual‐Leone, Josep Valls‐Solé,

Pain Management and Treatment

Abstract Background Neuropathic pain ( NP ) is common in spinal cord injury ( SCI ) patients. One of its manifestations is a lowering of pain perception threshold in quantitative thermal testing ( QTT ) in dermatomes rostral to the injury level. Transcranial direct current stimulation ( tDCS ) combined with visual illusion ( VI ) improves pain in SCI patients. We studied whether pain relief with tDCS + VI intervention is accompanied by a change in contact heat‐ evoked potentials ( CHEPs ) or in QTT . Methods We examined 18 patients with SCI and NP before and after 2 weeks of daily tDCS + VI intervention. Twenty SCI patients without NP and 14 healthy subjects served as controls. We assessed NP intensity using a numerical rating scale ( NRS ) and determined heat and pain thresholds with thermal probes. CHEPs were recorded to stimuli applied at C4 level, and subjects rated their perception of evoked pain using NRS during CHEPs . Results Thirteen patients reported a mean decrease of 50% in the NRS for NP after tDCS + VI . Evoked pain perception was significantly higher than in the other two groups, and reduced significantly together with CHEPs amplitude after tDCS + VI with respect to baseline. Pain perception threshold was significantly lower than in the other two groups before tDCS + VI intervention, and increased significantly afterwards. Conclusion Two weeks of tDCS + VI induced significant changes in CHEPs , evoked pain and heat pain threshold in SCI patients with NP . These neurophysiological tests might be objective biomarkers of treatment effects for NP in patients with SCI .