Front Hum Neurosci. 2016 Mar 10;10:68. doi: 10.3389/fnhum.2016.00068. eCollection 2016.
Transcranial Direct Current Stimulation Combined with Aerobic Exercise to Optimize Analgesic Responses in Fibromyalgia: A Randomized Placebo-Controlled Clinical Trial.
Frontiers in human neuroscience
Mariana E Mendonca, Marcel Simis, Luanda C Grecco, Linamara R Battistella, Abrahão F Baptista, Felipe Fregni
Affiliations
Affiliations
- Department of Neuroscience and Behavior, Institute of Psychology, University of São Paulo São Paulo, Brazil.
- Physical and Rehabilitation Medicine Institute of the University of São Paulo, Medical School General Hospital São Paulo, Brazil.
- Pediatric Neurosurgical Center - Rehabilitation (CENEPE)São Paulo, Brazil; Laboratory of Neuromodulation, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital and Massachusetts General HospitalBoston, MA, USA.
- Laboratory of Functional Electrostimulation, Department of Biomorphology, Federal University of Bahia Bahia, Brazil.
- Department of Neuroscience and Behavior, Institute of Psychology, University of São PauloSão Paulo, Brazil; Laboratory of Neuromodulation, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital and Massachusetts General HospitalBoston, MA, USA.
PMID: 27014012
PMCID: PMC4785149 DOI: 10.3389/fnhum.2016.00068
Abstract
UNLABELLED: 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, 364) = 2.25, p = 0.007] and tDCS [F (13, 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.
TRIAL REGISTRATION: (www.ClinicalTrials.gov), identifier NTC02358902.
Keywords: aerobic exercise; combined therapy; fibromyalgia; motor cortex; transcranial direct current stimulation (tDCS)
References
- Sports Med. 2000 Feb;29(2):85-98 - PubMed
- Clin Neurophysiol. 2000 Jun;111(6):994-1001 - PubMed
- J Am Coll Cardiol. 2001 Jan;37(1):153-6 - PubMed
- Lancet Neurol. 2003 Mar;2(3):145-56 - PubMed
- J Physiol. 2003 Nov 15;553(Pt 1):293-301 - PubMed
- Proc Natl Acad Sci U S A. 2004 Mar 2;101(9):3316-21 - PubMed
- Sports Med. 1992 Jan;13(1):25-36 - PubMed
- Neurology. 2006 Nov 14;67(9):1568-74 - PubMed
- Arthritis Rheum. 2006 Dec;54(12):3988-98 - PubMed
- Pain Pract. 2007 Dec;7(4):297-306 - PubMed
- Br J Sports Med. 2009 Jan;43(1):22-4 - PubMed
- Alzheimers Dement. 2007 Apr;3(2 Suppl):S45-51 - PubMed
- Clin J Pain. 2009 Oct;25(8):691-5 - PubMed
- J Pain. 2010 May;11(5):436-42 - PubMed
- Pain. 2010 Jun;149(3):495-500 - PubMed
- Neuron. 2010 Apr 29;66(2):198-204 - PubMed
- J Pain Symptom Manage. 2010 May;39(5):890-903 - PubMed
- J Head Trauma Rehabil. 2010 May-Jun;25(3):184-92 - PubMed
- Brain Stimul. 2008 Jul;1(3):206-23 - PubMed
- Brain. 2010 Sep;133(9):2565-77 - PubMed
- J Pain Manag. 2009;2(3):353-361 - PubMed
- J Rheumatol. 2011 Jun;38(6):1113-22 - PubMed
- J Pain. 2011 May;12(5):610-7 - PubMed
- Open Rheumatol J. 2011;5:45-50 - PubMed
- Headache. 2012 Sep;52(8):1283-95 - PubMed
- Pain Pract. 2013 Feb;13(2):131-45 - PubMed
- Brain Stimul. 2013 May;6(3):424-32 - PubMed
- Pain Physician. 2012 Jul;15(3 Suppl):ES205-13 - PubMed
- J Rehabil Med. 2013 Jan;45(1):6-13 - PubMed
- NeuroRehabilitation. 2013;33(1):49-56 - PubMed
- Clin Neurophysiol. 2014 Feb;125(2):298-305 - PubMed
- Cochrane Database Syst Rev. 2013 Sep 10;(9):CD009796 - PubMed
- Neurorehabil Neural Repair. 2014 Mar-Apr;28(3):250-9 - PubMed
- Cochrane Database Syst Rev. 2014 Apr 11;(4):CD008208 - PubMed
- J Pain. 2014 Aug;15(8):845-55 - PubMed
- Med Hypotheses. 2014 Sep;83(3):332-6 - PubMed
- Exp Brain Res. 2014 Oct;232(10):3345-51 - PubMed
- J Phys Ther Sci. 2014 Oct;26(10):1561-5 - PubMed
- J Back Musculoskelet Rehabil. 2015;28(4):609-19 - PubMed
- Sports Med. 1995 Sep;20(3):160-88 - PubMed
- Sports Med. 1997 Jul;24(1):8-16 - PubMed
Publication Types