Transcranial direct current stimulation potential for pain management

Abstract

There is emerging evidence that tDCS can be used to help manage acute post-operative pain, chronic pain syndromes or headache. The initial part of the chapter provides a brief introduction, followed by a review of evidence and methodological considerations for tDCS use in acute postoperative pain. Cortical targets for stimulation may vary depending upon the location of the acute post-surgical pain in question. Motor cortex stimulation has been found to reduce post-operative opioid requirements and pain ratings in total knee arthroplasty as well as post-lumbar surgery pain while prefrontal cortex stimulation has had similar effects in patients undergoing endoscopic retrograde cholangiopancreatography and total knee arthroplasty. Further, the chapter presents methodological considerations and exemplar evidence gained from tDCS applications in patients with difficult-to-treat chronic pain syndromes. This is followed by an overview of tDCS potential for symptom management in headaches, and the chapter also discusses putative mechanisms underlying tDCS analgesic effects, as well as practical aspects of tDCS application in pain populations. The exemplar studies presented in this chapter represent a change of archetype in the pain field, with a focus on examining and modulating the major central mechanisms associated with pain pathophysiology and relief. The conclusions of the chapter emphasize the overall potential of tDCS for pain management, open questions and anticipated future developments in this field.