Modulatory effects of transcranial direct current stimulation on laser-evoked potentials.

OBJECTIVE: Invasive stimulation of the motor cortex has been used for years to alleviate chronic intractable pain in humans. In our study, we have investigated the effect of transcranial direct current stimulation (tDCS), a noninvasive stimulation method, for manipulating the excitability of cortical motor areas on laser evoked potentials (LEP) and acute pain perception. DESIGNS AND SETTINGS: The amplitude of the N1, N2, and P2 LEP components of 10 healthy volunteers were evaluated prior to and following anodal, cathodal, and sham stimulation of the primary motor cortex. In a separate experiment subjective, pain rating scores of 16 healthy subjects in two perceptual categories (warm sensation, mild pain) were also analyzed. RESULTS: Cathodal tDCS significantly reduced the amplitude of N2 and P2 components compared with anodal or sham stimulation. However, neither of the tDCS types modified significantly the laser energy values necessary to induce moderate pain. In a separate experiment, cathodal stimulation significantly diminished mild pain sensation only when laser-stimulating the hand contralateral to the side of tDCS, while anodal stimulation modified warm sensation. CONCLUSIONS: The possible underlying mechanisms of our findings in view of recent neuroimaging studies are discussed. To our knowledge this study is the first to demonstrate the mild antinociceptive effect of tDCS over the primary motor cortex in healthy volunteers.

Theta burst stimulation of the motor cortex reduces laser-evoked pain perception.

Repetitive transcranial magnetic stimulation over the primary motor cortex (M1) was recently introduced to modulate pain perception. The aim of this double-blind cross-over study was to investigate the effect of a modified rTMS paradigm, called cTBS on experimentally induced laser-evoked pain applied over the left M1. cTBS inhibits the cortical excitability of the M1 for approximately 1 h. Subjective pain was measured using the verbal analogue scale prior to, immediately after and 30 min post-stimulation. cTBS, and not the sham stimulation resulted in a significant decrease in pain perception on both hands, accentuated on the right hand. Further studies are needed using motor cortex TBS in chronic pain to pave the way towards a therapeutic tool.