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Case Reports
. 2016 Jan 11:9:498.
doi: 10.3389/fnins.2015.00498. eCollection 2015.

Neuroplastic Effects of Transcranial Direct Current Stimulation on Painful Symptoms Reduction in Chronic Hepatitis C: A Phase II Randomized, Double Blind, Sham Controlled Trial

Aline P Brietzke  1 , Joanna R Rozisky  1 , Jairo A Dussan-Sarria  1 , Alicia Deitos  1 , Gabriela Laste  1 , Priscila F T Hoppe  1 , Suzana Muller  1 , Iraci L S Torres  1 , Mário R Alvares-da-Silva  2 , Rivadavio F B de Amorim  3 , Felipe Fregni  3 , Wolnei Caumo  1
Affiliations
Case Reports

Neuroplastic Effects of Transcranial Direct Current Stimulation on Painful Symptoms Reduction in Chronic Hepatitis C: A Phase II Randomized, Double Blind, Sham Controlled Trial

Aline P Brietzke et al. Front Neurosci. .

Abstract

Introduction: Pegylated Interferon Alpha (Peg-IFN) in combination with other drugs is the standard treatment for chronic hepatitis C infection (HCV) and is related to severe painful symptoms. The aim of this study was access the efficacy of transcranial direct current stimulation (tDCS) in controlling the painful symptoms related to Peg-IFN side effects.

Materials and methods: In this phase II double-blind trial, twenty eight (n = 28) HCV subjects were randomized to receive either 5 consecutive days of active tDCS (n = 14) or sham (n = 14) during 5 consecutive days with anodal stimulation over the primary motor cortex region using 2 mA for 20 min. The primary outcomes were visual analogue scale (VAS) pain and brain-derived neurotrophic factor (BDNF) serum levels. Secondary outcomes were the pressure-pain threshold (PPT), the Brazilian Profile of Chronic Pain: Screen (B-PCP:S), and drug analgesics use.

Results: tDCS reduced the VAS scores (P < 0.003), with a mean pain drop of 56% (p < 0.001). Furthermore, tDCS was able to enhance BDNF levels (p < 0.01). The mean increase was 37.48% in the active group. Finally, tDCS raised PPT (p < 0.001) and reduced the B-PCP:S scores and analgesic use (p < 0.05).

Conclusions: Five sessions of tDCS were effective in reducing the painful symptoms in HCV patients undergoing Peg-IFN treatment. These findings support the efficacy of tDCS as a promising therapeutic tool to improve the tolerance of the side effects related to the use of Peg-IFN. Future larger studies (phase III and IV trials) are needed to confirm the clinical use of the therapeutic effects of tDCS in such condition.

Trial registration: Brazilian Human Health Regulator for Research with the approval number CAAE 07802012.0.0000.5327.

Keywords: Hepatitis C; Hepatitis C virus; PEG-IFN; chronic pain; transcranial direct current stimulation.

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Figures

Figure 1
Figure 1
Randomization and follow-up of the study subjects.
Figure 2
Figure 2
Pain VAS scores at baseline and during the treatment. The error bars indicate the standard error of the mean (SEM). Asterisks (*) positioned above the symbols indicate significant differences (p < 0.01) at those time points using Anova model type III test.
Figure 3
Figure 3
Mean serum BDNF levels at baseline and after treatment. Asterisk (*) positioned above the symbols indicate significant differences (p < 0.01).
Figure 4
Figure 4
Mean pain threshold at baseline and at the end of treatment. The error bars indicate the standard error of the mean (SEM). Asterisks (*) positioned above the symbols indicate significant differences (p < 0.001).
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