Transcranial Direct Current Stimulation Combined with Aerobic Exercise to Optimize Analgesic Responses in Fibromyalgia: A Randomized Placebo-Controlled Clinical Trial

Author(s)

Mendonca, Mariana E. ^[1] ; Simis, Marcel ^[2] ; Grecco, Luanda C. ^{[3, 4, 5]} ; Battistella, Linamara R. ^[2] ; Baptista, Abrahao F. ^[6] ; Fregni, Felipe ^{[1, 3, 4]}

Affiliation

^[1] Univ Sao Paulo, Inst Psychol, Dept Neurosci & Behav, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Sch Med, Gen Hosp, Phys & Rehabil Med Inst, Sao Paulo - Brazil

^[3] Harvard Univ, Sch Med, Dept Phys Med & Rehabil, Spaulding Rehabil Hosp, Lab Neuromodulat, Boston, MA - USA

^[4] Massachusetts Gen Hosp, Boston, MA 02114 - USA

^[5] Pediat Neurosurg Ctr Rehabil CENEPE, Sao Paulo - Brazil

^[6] Univ Fed Bahia, Dept Biomorphol, Lab Funct Electrostimulat, BR-41170290 Salvador, BA - Brazil

• Document type: Journal article
• Source: FRONTIERS IN HUMAN NEUROSCIENCE; v. 10, MAR 10 2016.
• Web of Science Citations: 34

Abstract

Fibromyalgia is a chronic pain syndrome that is associated with maladaptive plasticity in neural central circuits. One of the neural circuits that are involved in pain in fibromyalgia is the primary motor cortex. We tested a combination intervention that aimed to modulate the motor system: transcranial direct current stimulation (tDCS) of the primary motor cortex (M1) and aerobic exercise (AE). In this phase II, sham-controlled randomized clinical trial, 45 subjects were assigned to 1 of 3 groups: tDCS + AE, AE only, and tDCS only. The following outcomes were assessed: intensity of pain, level of anxiety, quality of life, mood, pressure pain threshold, and cortical plasticity, as indexed by transcranial magnetic stimulation. There was a significant effect for the group-time interaction for intensity of pain, demonstrating that tDCS/AE was superior to AE {[}F-(13,F- 364) = 2.25, p = 0.007] and tDCS {[}F-(13,F- 364) = 2.33, p = 0.0056] alone. Post-hoc adjusted analysis showed a difference between tDCS/AE and tDCS group after the first week of stimulation and after 1 month intervention period (p = 0.02 and p = 0.03, respectively). Further, after treatment there was a significant difference between groups in anxiety and mood levels. The combination treatment effected the greatest response. The three groups had no differences regarding responses in motor cortex plasticity, as assessed by TMS. The combination of tDCS with aerobic exercise is superior compared with each individual intervention (cohen's d effect sizes > 0.55). The combination intervention had a significant effect on pain, anxiety and mood. Based on the similar effects on cortical plasticity outcomes, the combination intervention might have affected other neural circuits, such as those that control the affective-emotional aspects of pain. (AU)

• FAPESP's process: 12/06519-5 - Effect of transcranial direct current stimulation associated with aerobic exercises on pain of patients with fibromyalgia
• Grantee: Felipe Fregni
• Support Opportunities: Regular Research Grants