Giulia Fregna (Doctoral Program in Translational Neurosciences and Neurotechnologies, University of Ferrara, Italy)
Annibale Antonioni (Doctoral Program in Translational Neurosciences and Neurotechnologies, University of Ferrara, Italy)
Andrea Baroni (Department of Neuroscience and Rehabilitation, University of Ferrara)
Ishtiaq Ahmed (Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium)
Sofia Straudi (Department of Neuroscience and Rehabilitation, University of Ferrara)
A crucial goal of current research is to find cost-effective solutions to improve pain management and noninvasive brain stimulation (NIBS) techniques represent a promising intervention for managing pain of different aetiology1. Among these, transcranial direct current stimulation (tDCS) is widely used to treat pain symptomatology and it has been recently tested as a remote intervention, delivered at home by the patient and caregiver after specific training or under remote supervision2,3. However, the studies published so far were mainly characterized by small sample sizes, high heterogeneity, thus, limited generalizability of findings.
We performed a systematic review and meta-analysis to evaluate the effectiveness of home-based tDCS (alone or as an adjunct to other noninvasive treatments) in managing various types of pain compared to other noninvasive (home-based or not) interventions.
This systematic review and meta-analysis was pre-registered on PROSPERO registry. The following electronic bibliographic databases were searched for eligible articles: MEDLINE (via PubMed), EMBASE, Scopus (via EBSCO), Web of Science, and the Cochrane Library. Grey literature was screened through research from institutional repositories or online platforms. Specific search strings were used for each queried database. We included papers involving patients affected by pain (regardless of type and underlying pathology) treated with home-based tDCS (both self-administered or remotely supervised, alone or in combination with or as augmentation for other noninvasive treatments) for the management of various types of pain. We collected data on clinical conditions, interventions, comparators, outcome measures, adverse effects, and risk of bias. Furthermore, the GRADE assessment was carried out.
We included 12 randomized controlled trials (RCTs) with 404 participants with pain. Low certainty evidence from the meta-analysis showed that home-based tDCS might produce large and clinically meaningful improvement in pain intensity at the end of the intervention. Sub-group analysis showed clinically significant improvement in pain intensity in fibromyalgia and beneficial effects on pain pressure threshold, heat pain threshold, and heat pain tolerance in people with knee osteoarthritis. Further, tDCS appeared to be generally safe, well-accepted and easily applied at home.
Our synthesized evidence suggests that remote self-administered tDCS is a safe and effective tool for managing various types of pain and supports its use in home-based pain treatment.
