Effects of rTMS and tDCS on neuropathic pain after brachial plexus injury: a randomized placebo-controlled pilot study

• Published in: Scientific reports Vol. 12; no. 1; p. 1440
• Main Authors: Bonifácio de Assis, Erickson Duarte, Martins, Wanessa Kallyne Nascimento, de Carvalho, Carolina Dias, Ferreira, Clarice Martins, Gomes, Ruth, de Almeida Rodrigues, Evelyn Thais, Meira, Ussânio Mororó, de Holanda, Ledycnarf Januário, Lindquist, Ana Raquel, Morya, Edgard, Mendes, Cristina Katya Torres Teixeira, de Assis, Thaís Castro Gomes, de Oliveira, Eliane Araújo, Andrade, Suellen Marinho
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 27.01.2022; Nature Publishing Group UK; Nature Portfolio
• Subjects: Adult; Anxiety; Anxiety - etiology; Anxiety - psychology; Anxiety - therapy; Brachial plexus; Brachial Plexus - injuries; Clinical trials; Cortex (motor); Cross-Over Studies; Double-Blind Method; Female; Humans; Magnetic fields; Male; Neuralgia; Neuralgia - diagnosis; Neuralgia - etiology; Neuralgia - psychology; Neuralgia - therapy; Pain; Pain Management - methods; Pain Measurement - statistics & numerical data; Patients; Pilot Projects; Placebos; Quality of Life; Transcranial Direct Current Stimulation - methods; Transcranial magnetic stimulation; Transcranial Magnetic Stimulation - methods; Treatment Outcome; Young Adult
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-022-05254-3

Neuropathic pain after brachial plexus injury (NPBPI) is a highly disabling clinical condition and is increasingly prevalent due to increased motorcycle accidents. Currently, no randomized controlled trials have evaluated the effectiveness of non-invasive brain stimulation techniques such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct-current stimulation (tDCS) in patients suffering from NPBPI. In this study, we directly compare the efficacy of 10-Hz rTMS and anodal 2 mA tDCS techniques applied over the motor cortex (5 daily consecutive sessions) in 20 patients with NPBPI, allocated into 2 parallel groups (active or sham). The order of the sessions was randomised for each of these treatment groups according to a crossover design and separated by a 30-day interval. Scores for "continuous" and "paroxysmal" pain (primary outcome) were tabulated after the last stimulation day and 30 days after. Secondary outcomes included the improvement in multidimensional aspects of pain, anxiety state and quality of life from a qualitative and quantitative approach. Active rTMS and tDCS were both superior to sham in reducing continuous (p < 0.001) and paroxysmal (p = 0.002; p = 0.02) pain as well as in multidimensional aspects of pain (p = 0.001; p = 0.002) and anxiety state (p =  < 0.001; p = 0.005). Our results suggest rTMS and tDCS are able to treat NPBPI with little distinction in pain and anxiety state, which may promote the use of tDCS in brachial plexus injury pain management, as it constitutes an easier and more available technique.Clinical Trial Registration: http://www.ensaiosclinicos.gov.br/, RBR-5xnjbc - Sep 3, 2018.