Transcranial direct current stimulation helps reduce visceral pain in HCC patients
Transcranial direct current stimulation (tDCS) appears to be an effective and clinically relevant strategy in managing visceral pain associated with hepatocellular carcinoma (HCC), according to a study.
A total of 40 patients with visceral pain due to HCC were randomly assigned into two groups: a real and a sham group. Patients in the real group received tDCS applied over the primary motor area (M1) for 10 consecutive days (2 mA for 30 minutes).
Pain was evaluated using visual analogue scale (VAS) and verbal descriptor scale (VDS), whereas depression was evaluated using the Hamilton rating scale (HAM-D). Assessments were performed at different time points: prestimulation, after the first, fifth and 10th sessions, and one month after the end of stimulation sessions.
Real tDCS yielded significant improvements in VDS (p=0.001) and VAS (p=0.001), as well as in HAM-D (p=0.012), with the effect seen at fifth session and sustained through 1 month after stimulation. On the other hand, the effect observed with sham treatment persisted for 5 days only.
A noninvasive and simple neurostimulation technique, tDCS uses a cathode and anode applied to the head using a low intensity direct current to stimulate the surface of the skull. The stimulation exerts an effect on the brain’s motor cortex excitability, which corresponds to area M1 in humans. Anode stimulation reduces GABA concentrations in the cerebral cortex, while that of the cathode generates a homeostatic effect. [https://cdn.intechopen.com/pdfs-wm/46411.pdf]
TDCS is indicated for chronic neuropathic pain, including refractory orofacial pain and pain after endoscopic retrograde cholangiopancreatography, trigeminal pain, fibromyalgia, phantom pain, and back pain. The strategy is also used in the treatment of psychiatric disorders such as depression (including severe depression), bipolar disorder, schizophrenia, Alzheimer's disease and modulation of associative learning. Therapeutic indications in neurological diseases include Parkinson's disease, postictal problems after stroke and tinnitus. [Clin J Pain 2013;29:621-2; Behav Brain Res 2013;236:8-15; Pain 2013;154:1274-80]