Does anodal transcranial direct current stimulation over left motor cortex show body side pain-related difference in fibromyalgia?

Matias, Monayane Grazielly Leite; Cavalcante, Antônio Felipe Lopes; Mescouto, Karime Andrade; Silva Filho, Edson Meneses; Baptista, Abrahão Fontes; Okano, Alexandre Hideki; Pegado, Rodrigo

doi:10.5935/2595-0118.20220020

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ORIGINAL ARTICLE • BrJP 05 (02) • Apr-Jun 2022 • https://doi.org/10.5935/2595-0118.20220020 linkcopy

Does anodal transcranial direct current stimulation over left motor cortex show body side pain-related difference in fibromyalgia?

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES: Fibromyalgia (FM) is a chronic widespread musculoskeletal pain resulting in central sensitization of nociceptive signaling. Transcranial direct current stimulation (tDCS) over the left motor cortex (M1) is a non-invasive neuromodulation technique indicated for a broad range of chronic pain disorders, including FM. Studies suggest that left and right M1 (contralateral and ipsilateral hemisphere of tDCS stimulation) are modulated. But it is necessary to clarify the differences in clinical pain perception comparing the right and left side of the body. This study aimed to evaluate the pain-related difference between right-left side of the body after five sessions of anodal tDCS in women with FM.

METHODS: A double-blinded, parallel, randomized, sham-controlled trial with 30 women with FM was performed. Five sessions of anodal C3 and cathodal supraorbital (Fp2) tDCS were conducted (2 mA for 20 min). Pain, impact of FM and anxiety were evaluated. No statistically significant three-way interaction between time, stimulation type and body side were found.

RESULTS: Active-tDCS showed significant improvement in pain, but impact of FM and anxiety did not show significant improvement.

CONCLUSION: Five sessions of anodal tDCS over the left M1 improves pain in women with FM, however there was no difference between right-left body sides.

Keywords:
Chronic pain; Fibromyalgia; Motor cortex; Noninvasive brain stimulation; Transcranial direct current stimulation

Clinical and demographic data	Active-tDCS (mean ± SD)	Sham-tDCS (mean ± SD)	P-value
Age (years)	49.40 ± 11.89	51.73 ± 12.44	0.60
FIQ	70.3 ± 13.34	63.02 ± 15.47	0.17
NRS	6.24 ± 1,63	6.69 ± 1.94	0.50
Threshold right side*	1.4 ± 0.57	1.78 ± 0.73	0.12
Threshold left side*	1.92 ± 0.79	1.92 ± 0.65	0.09
Anxiety (HAS)	31.07 ± 7.46	34.73 ± 10.12	0.26
Income** (%)			0.17
1 minimum wage	6.7	29.4
2 to 3 minimum wage	53.3	41.2
4 minimum wage or more	33.3	11.8
Unreported	6.7	17.6
Marital status (%)			0.73
Married	60	41.2
Never married	26.7	41.2
Widowed	6.7	5.9
Divorced	6.7	11.8
Schooling (%)			0.56
Elementary (incomplete)	0	5.9
Elementary	26.7	23.5
Secondary	26.7	41.2
University	46.7	29,4

Tender pointscomparations	ANOVA Factor
Tender pointscomparations	(1) Time		(2) Group		(3) Body side		Interaction 1 by 2		Interaction 1 by 3		Interaction 2 by 3		Interaction 1 by 2 by 3
	f-value	p-value	f-value	p-value	f-value	p-value	f-value	p-value	f-value	p-value	f-value	p-value	f-value	p-value
1x2	0.51	0.65	2.37	0.14	4.43	0.05	2.33	0.11	1.22	0.31	1.24	0.28	1.22	0.31
3x4	0.53	0.59	1.53	0.23	2.09	0.17	0.62	0.54	0.76	0.47	2.22	0.15	1.54	0.23
5x6	1.33	0.28	3.46	0.08	1.55	0.23	0.38	0.68	0.00	0.99	0.06	0.79	2.11	0.14
7x8	1.16	0.32	1.21	0.28	1.58	0.22	1.72	0.19	0.79	0.46	0.001	0.96	1.2	0.29
9x10	4.39	0.02*	0.49	0.49	4.75	0.04*	1.23	0.30	1.75	0.19	0.01	0.89	0.26	0.77
11x12	3.27	0.05*	2.57	0.13	0.72	0.40	0.42	0.65	1.73	0.19	0.01	0.89	0.11	0.34
13x14	0.98	0.38	1.63	0.22	21.15	0.0001*	2.54	0.09	0.06	0.93	1.41	0.25	1.94	0.16
15x16	1.69	0.2	0.69	0.41	0.7	0.41	4.25	0.04*	0.35	0.7	2.15	0.16	0.85	0.43
12x18	0.45	0.64	0.02	0.88	6.28	0.25	0.51	0.54	0.82	0.45	2.92	0.1	0.5	0.61

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[TFN1] SD = Standard Deviation; FIQ = Fibromyalgia Impact Questionnaire; NRS = Numeric Rating Scale; HAS = Hamilton Anxiety Scale. Numeric data were calculated using unpaired t test. Categorical data were calculated using Chisquare test. Threshold and tolerance were calculated with the mean of the 9 tender points on left side of the body and 9 points on right side of the body according to ACR. *Values in kg/cm² **Brazilian National Minimum Wage, US$ 257.56 per month.