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Transcranial Direct Current Stimulation (tDCS) Targeting Left Dorsolateral Prefrontal Cortex Modulates Task-Induced Acute Pain in Healthy Volunteers.
Pain Med. 2016 Apr; 17(4):737-45.PM

Abstract

OBJECTIVE

Current chronic pain treatments target nociception rather than affective "suffering" and its associated functional and psychiatric comorbidities. The left dorsolateral prefrontal cortex (DLPFC) has been implicated in affective, cognitive, and attentional aspects of pain and is a primary target of neuromodulation for affective disorders. Transcranial direct current stimulation (tDCS) can non-invasively modulate cortical activity. The present study tests whether anodal tDCS targeting the left DLPFC will increase tolerability of acute painful stimuli vs cathodal tDCS.

METHODS

Forty tDCS-naive healthy volunteers received anodal and cathodal stimulation targeting the left DLPFC in two randomized and counterbalanced sessions. During stimulation, each participant performed cold pressor (CP) and breath holding (BH) tasks. We measured pain intensity with the Defense and Veterans Pain Rating Scale (DVPRS) before and after each task.

RESULTS

Mixed ANOVA revealed no main effect of stimulation polarity for mean CP threshold, tolerance, or endurance, or mean BH time (allP > 0.27). However, DVPRS rise associated with CP was significantly smaller with anodal vs cathodal tDCS (P = 0.024). We further observed a significant tDCS polarity × stimulation order interaction (P = 0.042) on CP threshold, suggesting task sensitization.

CONCLUSIONS

Although our results do not suggest that polarity of tDCS targeting the left DLPFC differentially modulates the tolerability of CP- and BH-related pain distress in healthy volunteers, there was a significant effect on DVPRS pain ratings. This contrasts with our previous findings that tDCS targeting the left dorsal anterior cingulate cortex showed a trend toward higher mean CP tolerance with cathodal vs anodal stimulation. The present results may suggest tDCS-related effects on nociception or DLPFC-mediated attention, or preferential modulation of the affective valence of pain as captured by the DVPRS. Sham-controlled clinical studies are needed.

Authors+Show Affiliations

*Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island Center of Excellence for Neurorestoration and Neurotechnology, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA mariano@post.harvard.edu.*Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island Center of Excellence for Neurorestoration and Neurotechnology, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.*Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island.*Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island Center of Excellence for Neurorestoration and Neurotechnology, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.*Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island Center of Excellence for Neurorestoration and Neurotechnology, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

26814276

Citation

Mariano, Timothy Y., et al. "Transcranial Direct Current Stimulation (tDCS) Targeting Left Dorsolateral Prefrontal Cortex Modulates Task-Induced Acute Pain in Healthy Volunteers." Pain Medicine (Malden, Mass.), vol. 17, no. 4, 2016, pp. 737-45.
Mariano TY, Van't Wout M, Garnaat SL, et al. Transcranial Direct Current Stimulation (tDCS) Targeting Left Dorsolateral Prefrontal Cortex Modulates Task-Induced Acute Pain in Healthy Volunteers. Pain Med. 2016;17(4):737-45.
Mariano, T. Y., Van't Wout, M., Garnaat, S. L., Rasmussen, S. A., & Greenberg, B. D. (2016). Transcranial Direct Current Stimulation (tDCS) Targeting Left Dorsolateral Prefrontal Cortex Modulates Task-Induced Acute Pain in Healthy Volunteers. Pain Medicine (Malden, Mass.), 17(4), 737-45. https://doi.org/10.1093/pm/pnv042
Mariano TY, et al. Transcranial Direct Current Stimulation (tDCS) Targeting Left Dorsolateral Prefrontal Cortex Modulates Task-Induced Acute Pain in Healthy Volunteers. Pain Med. 2016;17(4):737-45. PubMed PMID: 26814276.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transcranial Direct Current Stimulation (tDCS) Targeting Left Dorsolateral Prefrontal Cortex Modulates Task-Induced Acute Pain in Healthy Volunteers. AU - Mariano,Timothy Y, AU - Van't Wout,Mascha, AU - Garnaat,Sarah L, AU - Rasmussen,Steven A, AU - Greenberg,Benjamin D, Y1 - 2015/12/11/ PY - 2015/07/31/received PY - 2015/09/30/accepted PY - 2016/1/28/entrez PY - 2016/1/28/pubmed PY - 2017/1/28/medline KW - DLPFC KW - Dorsolateral Prefrontal Cortex KW - Neuromodulation KW - Pain KW - Transcranial Direct Current Stimulation KW - tDCS SP - 737 EP - 45 JF - Pain medicine (Malden, Mass.) JO - Pain Med VL - 17 IS - 4 N2 - OBJECTIVE: Current chronic pain treatments target nociception rather than affective "suffering" and its associated functional and psychiatric comorbidities. The left dorsolateral prefrontal cortex (DLPFC) has been implicated in affective, cognitive, and attentional aspects of pain and is a primary target of neuromodulation for affective disorders. Transcranial direct current stimulation (tDCS) can non-invasively modulate cortical activity. The present study tests whether anodal tDCS targeting the left DLPFC will increase tolerability of acute painful stimuli vs cathodal tDCS. METHODS: Forty tDCS-naive healthy volunteers received anodal and cathodal stimulation targeting the left DLPFC in two randomized and counterbalanced sessions. During stimulation, each participant performed cold pressor (CP) and breath holding (BH) tasks. We measured pain intensity with the Defense and Veterans Pain Rating Scale (DVPRS) before and after each task. RESULTS: Mixed ANOVA revealed no main effect of stimulation polarity for mean CP threshold, tolerance, or endurance, or mean BH time (allP > 0.27). However, DVPRS rise associated with CP was significantly smaller with anodal vs cathodal tDCS (P = 0.024). We further observed a significant tDCS polarity × stimulation order interaction (P = 0.042) on CP threshold, suggesting task sensitization. CONCLUSIONS: Although our results do not suggest that polarity of tDCS targeting the left DLPFC differentially modulates the tolerability of CP- and BH-related pain distress in healthy volunteers, there was a significant effect on DVPRS pain ratings. This contrasts with our previous findings that tDCS targeting the left dorsal anterior cingulate cortex showed a trend toward higher mean CP tolerance with cathodal vs anodal stimulation. The present results may suggest tDCS-related effects on nociception or DLPFC-mediated attention, or preferential modulation of the affective valence of pain as captured by the DVPRS. Sham-controlled clinical studies are needed. SN - 1526-4637 UR - https://www.unboundmedicine.com/medline/citation/26814276/Transcranial_Direct_Current_Stimulation__tDCS__Targeting_Left_Dorsolateral_Prefrontal_Cortex_Modulates_Task_Induced_Acute_Pain_in_Healthy_Volunteers_ L2 - https://academic.oup.com/painmedicine/article-lookup/doi/10.1093/pm/pnv042 DB - PRIME DP - Unbound Medicine ER -