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Review
. 2019 Jan 9;4(1):e692.
doi: 10.1097/PR9.0000000000000692. eCollection 2019 Jan-Feb.

Latin American and Caribbean consensus on noninvasive central nervous system neuromodulation for chronic pain management (LAC2-NIN-CP)

Abrahão Fontes Baptista  1   2   3   4 , Ana Mércia B L Fernandes  5 , Katia Nunes Sá  2 , Alexandre Hideki Okano  1 , André Russowsky Brunoni  6   7 , Argelia Lara-Solares  8 , Aziza Jreige Iskandar  9 , Carlos Guerrero  10 , César Amescua-García  11 , Durval Campos Kraychete  3 , Egas Caparelli-Daquer  12 , Elias Atencio  13 , Fabián Piedimonte  14 , Frantz Colimon  15 , Fuad Ahmed Hazime  16 , João Batista S Garcia  17 , John Jairo Hernández-Castro  18 , José Alberto Flores Cantisani  19 , Kátia Karina do Monte-Silva  20 , Luis Claudio Lemos Correia  2   21 , Manuel Sempértegui Gallegos  22 , Marco Antonio Marcolin  5 , María Antonieta Ricco  23 , María Berenguel Cook  24 , Patricia Bonilla  25 , Pedro Schestatsky  26 , Ricardo Galhardoni  5   6   7   27 , Valquíria Silva  5 , William Delgado Barrera  28 , Wolnei Caumo  26 , Didier Bouhassira  29 , Lucy S Chipchase  30 , Jean-Pascal Lefaucheur  31 , Manoel Jacobsen Teixeira  5 , Daniel Ciampi de Andrade  5   6   7   32   33
Affiliations
Review

Latin American and Caribbean consensus on noninvasive central nervous system neuromodulation for chronic pain management (LAC2-NIN-CP)

Abrahão Fontes Baptista et al. Pain Rep. .

Abstract

Introduction: Chronic pain (CP) is highly prevalent and generally undertreated health condition. Noninvasive brain stimulation may contribute to decrease pain intensity and influence other aspects related to CP.

Objective: To provide consensus-based recommendations for the use of noninvasive brain stimulation in clinical practice.

Methods: Systematic review of the literature searching for randomized clinical trials followed by consensus panel. Recommendations also involved a cost-estimation study.

Results: The systematic review wielded 24 transcranial direct current stimulation (tDCS) and 22 repetitive transcranial magnetic stimulation (rTMS) studies. The following recommendations were provided: (1) Level A for anodal tDCS over the primary motor cortex (M1) in fibromyalgia, and level B for peripheral neuropathic pain, abdominal pain, and migraine; bifrontal (F3/F4) tDCS and M1 high-definition (HD)-tDCS for fibromyalgia; Oz/Cz tDCS for migraine and for secondary benefits such as improvement in quality of life, decrease in anxiety, and increase in pressure pain threshold; (2) level A recommendation for high-frequency (HF) rTMS over M1 for fibromyalgia and neuropathic pain, and level B for myofascial or musculoskeletal pain, complex regional pain syndrome, and migraine; (3) level A recommendation against the use of anodal M1 tDCS for low back pain; and (4) level B recommendation against the use of HF rTMS over the left dorsolateral prefrontal cortex in the control of pain.

Conclusion: Transcranial DCS and rTMS are recommended techniques to be used in the control of CP conditions, with low to moderate analgesic effects, and no severe adverse events. These recommendations are based on a systematic review of the literature and a consensus made by experts in the field. Readers should use it as part of the resources available to decision-making.

Keywords: Mixed pain; Neuropathic pain; Nociceptive pain; rTMS; tDCS.

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Conflict of interest statement

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1.
Figure 1.
Study flowchart. rTMS, repetitive transcranial magnetic stimulation; tDCS, transcranial direct current stimulation.
See this image and copyright information in PMC

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