Abigail Powers1, Alok Madan2,3, Megan Hilbert4, Scott T Reeves4, Mark George5,6, Michael R Nash7, Jeffrey J Borckardt4,5,6. 1. Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia. 2. The Menninger Clinic, Houston, Texas. 3. Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas. 4. Anesthesia and Perioperative Medicine. 5. Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina. 6. Ralph Johnson VAMC, Charleston, South Carolina. 7. University of Tennessee, Knoxville Department of Psychology.
Abstract
Objective: Cognitive behavioral therapy has been shown to be effective for treating chronic pain, and a growing literature shows the potential analgesic effects of minimally invasive brain stimulation. However, few studies have systematically investigated the potential benefits associated with combining approaches. The goal of this pilot laboratory study was to investigate the combination of a brief cognitive restructuring intervention and transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex in affecting pain tolerance. Design: Randomized, double-blind, placebo-controlled laboratory pilot. Setting: Medical University of South Carolina. Subjects: A total of 79 healthy adult volunteers. Methods:Subjects were randomized into one of six groups: 1) anodal tDCS plus a brief cognitive intervention (BCI); 2) anodal tDCS plus pain education; 3) cathodal tDCS plus BCI; 4) cathodal tDCS plus pain education; 5) sham tDCS plus BCI; and 6) sham tDCS plus pain education. Participants underwent thermal pain tolerance testing pre- and postintervention using the Method of Limits. Results: A significant main effect for time (pre-post intervention) was found, as well as for baseline thermal pain tolerance (covariate) in the model. A significant time × group interaction effect was found on thermal pain tolerance. Each of the five groups that received at least one active intervention outperformed the group receiving sham tDCS and pain education only (i.e., control group), with the exception of the anodal tDCS + education-only group. Cathodal tDCS combined with the BCI produced the largest analgesic effect. Conclusions: Combining cathodal tDCS with BCI yielded the largest analgesic effect of all the conditions tested. Future research might find stronger interactive effects of combined tDCS and a cognitive intervention with larger doses of each intervention. Because this controlled laboratory pilot employed an acute pain analogue and the cognitive intervention did not authentically represent cognitive behavioral therapy per se, the implications of the findings on chronic pain management remain unclear.
RCT Entities:
Objective: Cognitive behavioral therapy has been shown to be effective for treating chronic pain, and a growing literature shows the potential analgesic effects of minimally invasive brain stimulation. However, few studies have systematically investigated the potential benefits associated with combining approaches. The goal of this pilot laboratory study was to investigate the combination of a brief cognitive restructuring intervention and transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex in affecting pain tolerance. Design: Randomized, double-blind, placebo-controlled laboratory pilot. Setting: Medical University of South Carolina. Subjects: A total of 79 healthy adult volunteers. Methods: Subjects were randomized into one of six groups: 1) anodal tDCS plus a brief cognitive intervention (BCI); 2) anodal tDCS plus pain education; 3) cathodal tDCS plus BCI; 4) cathodal tDCS plus pain education; 5) sham tDCS plus BCI; and 6) sham tDCS plus pain education. Participants underwent thermal pain tolerance testing pre- and postintervention using the Method of Limits. Results: A significant main effect for time (pre-post intervention) was found, as well as for baseline thermal pain tolerance (covariate) in the model. A significant time × group interaction effect was found on thermal pain tolerance. Each of the five groups that received at least one active intervention outperformed the group receiving sham tDCS and pain education only (i.e., control group), with the exception of the anodal tDCS + education-only group. Cathodal tDCS combined with the BCI produced the largest analgesic effect. Conclusions: Combining cathodal tDCS with BCI yielded the largest analgesic effect of all the conditions tested. Future research might find stronger interactive effects of combined tDCS and a cognitive intervention with larger doses of each intervention. Because this controlled laboratory pilot employed an acute pain analogue and the cognitive intervention did not authentically represent cognitive behavioral therapy per se, the implications of the findings on chronic pain management remain unclear.
Authors: Roger B Fillingim; Adam J Woods; Hyochol Ahn; Samuel S Wu; David T Redden; Song Lai; Hrishikesh Deshpande; Georg Deutsch; Kimberly T Sibille; Roland Staud; Fadel Zeidan; Burel R Goodin Journal: Contemp Clin Trials Date: 2020-09-28 Impact factor: 2.226