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Randomized Controlled Trial
. 2014 Dec;30(12):1076-83.
doi: 10.1097/AJP.0000000000000069.

Pain reduction in myofascial pain syndrome by anodal transcranial direct current stimulation combined with standard treatment: a randomized controlled study

Piyaraid Sakrajai  1 , Taweesak Janyacharoen, Mark P Jensen, Kittisak Sawanyawisuth, Narong Auvichayapat, Orathai Tunkamnerdthai, Keattichai Keeratitanont, Paradee Auvichayapat
Affiliations
Randomized Controlled Trial

Pain reduction in myofascial pain syndrome by anodal transcranial direct current stimulation combined with standard treatment: a randomized controlled study

Piyaraid Sakrajai et al. Clin J Pain. 2014 Dec.

Abstract

Background: Myofascial pain syndrome (MPS) in the shoulder is among the most prevalent pain problems in the middle-aged population worldwide. Evidence suggests that peripheral and central sensitization may play an important role in the development and maintenance of shoulder MPS. Given previous research supporting the potential efficacy of anodal transcranial direct current stimulation (tDCS) for modulating pain-related brain activity in individuals with refractory central pain, we hypothesized that anodal tDCS when applied over the primary motor cortex (M1) combined with standard treatment will be more effective for reducing pain in patients with MPS than standard treatment alone.

Methods and materials: Study participants were randomized to receive either (1) standard treatment with 5 consecutive days of 1 mA anodal tDCS over M1 for 20 minutes; or (2) standard treatment plus sham tDCS. Measures of pain intensity, shoulder passive range of motion (PROM), analgesic medication use, and self-reported physical functioning were administered before treatment and again at posttreatment and 1-, 2-, 3-, and 4-week follow-up.

Results: Thirty-one patients with MPS were enrolled. Participants assigned to the active tDCS condition reported significantly more pretreatment to posttreatment reductions in pain intensity that were maintained at 1-week posttreatment, and significant improvement in shoulder adduction PROM at 1-week follow-up than participants assigned to the sham tDCS condition.

Conclusions: Five consecutive days of anodal tDCS over M1 combined with standard treatment appears to reduce pain intensity and may improve PROM, faster than standard treatment alone. Further tests on the efficacy and duration of effects of tDCS in the treatment of MPS are warranted.

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Conflict of interest statement

Conflict of Interest

The authors declare no financial or personal conflicts of interest associated with this study.

Figures

Figure 1
Figure 1
Consort diagram of participant flow.
Figure 2
Figure 2
Effect of treatment conditions on pain intensity (average of VAS intensity ratings). Data are presented as mean of VAS at baseline and at post-treatment (D0) and at 1-, 2-, 3-, and 4-week follow-up. Vertical lines represent SEM. ***p<0.0001, **p<0.001.
Figure 3
Figure 3
Effect of treatments on shoulder passive range of motion (PROM). Data are presented as mean of PROM at baseline and various time points after treatment: immediately (D0), 1, 2, 3, and 4 weeks after a 5-consecutive days tDCS. Vertical line represent SEM. *p=0.047.
Figure 4
Figure 4
Effect of treatment on number of primary analgesic (acetaminophen) tablets taken. Data are presented as mean of number of acetaminophen tablets taken at baseline and at 1-, 2-, 3-, and 4-week follow-up. Vertical lines represent SEM. ***p<0.001, **p=0.001.
Figure 5
Figure 5
Effect of treatment on physical functioning (WHOQOL Physical Functioning scale). Lower lines of the boxes represent the lowest physical score, middle lines of the boxes represent median, plus symbol represent mean and upper lines of the boxes represent the highest physical domain QOL at baseline and 4 weeks after 5-consecutive days tDCS. Vertical lines represent SEM.
See this image and copyright information in PMC

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