Pinto Camila Bonin, Teixeira Costa Beatriz, Duarte Dante, Fregni Felipe
From the Laboratory of Neuromodulation and Center for Clinical Research Learning, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA.
J ECT. 2018 Sep;34(3):e36-e50. doi: 10.1097/YCT.0000000000000518.
Transcranial direct current stimulation (tDCS) modulates spontaneous neuronal activity that can generate long-term neuroplastic changes. It has been used in numerous therapeutic trials showing significant clinical effects especially when combined with other behavioral therapies. One area of intensive tDCS research is chronic pain. Since the initial tDCS trials for chronic pain treatment using current parameters of stimulation, more than 60 clinical trials have been published testing its effects in different pain syndromes. However, as the field moves in the direction of clinical application, several aspects need to be taken into consideration regarding tDCS effectiveness and parameters of stimulation. In this article, we reviewed the evidence of tDCS effects for the treatment of chronic pain and critically analyzed the literature pertaining its safety and efficacy, and how to optimize tDCS clinical effects in a therapeutic setting. We discuss optimization of tDCS effects in 3 different domains: (i) parameters of stimulation, (ii) combination therapies, and (iii) subject selection. This article aims to provide insights for the development of future tDCS clinical trials.
经颅直流电刺激（tDCS）可调节能产生长期神经可塑性变化的自发神经元活动。它已被用于众多治疗试验，显示出显著的临床效果，尤其是与其他行为疗法联合使用时。tDCS的一个深入研究领域是慢性疼痛。自从最初使用当前刺激参数进行慢性疼痛治疗的tDCS试验以来，已经发表了60多项临床试验，测试其在不同疼痛综合征中的效果。然而，随着该领域朝着临床应用的方向发展，关于tDCS的有效性和刺激参数，有几个方面需要考虑。在本文中，我们回顾了tDCS治疗慢性疼痛效果的证据，并批判性地分析了有关其安全性和有效性的文献，以及如何在治疗环境中优化tDCS的临床效果。我们在3个不同领域讨论tDCS效果的优化：（i）刺激参数，（ii）联合疗法，以及（iii）受试者选择。本文旨在为未来tDCS临床试验的开展提供见解。
