Pain Management

Transcranial Electrical Stimulation for Pain

Transcranial Electrical Stimulation (TCES) treatment involves applying electrodes to an individual’s scalp to allow electrical current to be applied and presumably stimulate the underlying cerebrum (Tan et al. 2006).

Table 15. Transcranial Electrical Stimulation Post-SCI Pain

Author Year Country PEDro Score Research Design Total Sample Size	Methods	Outcome
Tan et al. 2006 USA RCT PEDro=10 N=38	Population: Type of pain=neuropathic and musculoskeletal. Intervention: Subjects received 1 hr Transcranial Electrical Stimulation (TCES) or sham TCES for 21 days to treat neuropathic or musculoskeletal pain. Following this, the control group was offered the opportunity to participate in an open-label TCES study. Outcome Measures: Brief Pain Inventory (BPI).	1. No significant difference between TCES and sham groups for BPI. However, several individual interference items were significantly reduced, from pre to post intervention, in the TCES group only. 2. For active TCES, average daily pain intensity from pre to post assessment decreased significantly (p=0.03) compared to the sham (control) group. 3. Significant reduction in daily pain intensity noted in treatment group (pre-post) (p=0.02) but not in control group (p=0.34). 4. During open label trial, a reduction in pain was noted after TCES treatment (p=0.003)
Capel et al.2003 Canada RCT PEDro=8 N=30	Population: Type of pain=neuropathic and musculoskeletal. Intervention: SCI subjects randomly assigned to one of two groups. Treatment group received transcranial electrostimulation (TCES) twice daily for 4 days, while controls received sham treatment. After an 8 wk washout period, treatments were reversed for sham treatment group only; thus, during the second half of the observation period, all received active treatment. Three subjects left the study early, two because of interactions between TCES and medications. Outcome Measures: Short form McGill Pain Questionnaire (SF-MPQ); State Trait Anxiety Inventory (STAI); Beck Depression Inventory (BDI).	1. During first part of the study, those on TCES reported less severe pain vs. baseline (p=0.0016); controls reported no change. 2. During phase two of study, control group (now receiving TCES) also reported significantly less pain (p<0.005). 3. Treatment group used fewer medications (analgesics and antidepressants) while receiving TCES (p<0.05). 4. Groups did not differ in pre-morbid psychological states (i.e., STAI, BDI) nor was treatment effect associated with mood in either group.

Author Year

Country

PEDro Score

Research Design

Total Sample Size

Methods

Outcome

Tan et al. 2006

USA

RCT

PEDro=10

N=38

Population: Type of pain=neuropathic and musculoskeletal.

Intervention: Subjects received 1 hr Transcranial Electrical Stimulation (TCES) or sham TCES for 21 days to treat neuropathic or musculoskeletal pain. Following this, the control group was offered the opportunity to participate in an open-label TCES study.

Outcome Measures: Brief Pain Inventory (BPI).

1. No significant difference between TCES and sham groups for BPI. However, several individual interference items were significantly reduced, from pre to post intervention, in the TCES group only.

2. For active TCES, average daily pain intensity from pre to post assessment decreased significantly (p=0.03) compared to the sham (control) group.

3. Significant reduction in daily pain intensity noted in treatment group (pre-post) (p=0.02) but not in control group (p=0.34).

4. During open label trial, a reduction in pain was noted after TCES treatment (p=0.003)

Capel et al.2003

Canada

RCT

PEDro=8

N=30

Population: Type of pain=neuropathic and musculoskeletal.

Intervention: SCI subjects randomly assigned to one of two groups. Treatment group received transcranial electrostimulation (TCES) twice daily for 4 days, while controls received sham treatment. After an 8 wk washout period, treatments were reversed for sham treatment group only; thus, during the second half of the observation period, all received active treatment. Three subjects left the study early, two because of interactions between TCES and medications.

Outcome Measures: Short form McGill Pain Questionnaire (SF-MPQ); State Trait Anxiety Inventory (STAI); Beck Depression Inventory (BDI).

1. During first part of the study, those on TCES reported less severe pain vs. baseline (p=0.0016); controls reported no change.

2. During phase two of study, control group (now receiving TCES) also reported significantly less pain (p<0.005).

3. Treatment group used fewer medications (analgesics and antidepressants) while receiving TCES (p<0.05).

4. Groups did not differ in pre-morbid psychological states (i.e., STAI, BDI) nor was treatment effect associated with mood in either group.

Discussion

Two RCTs found TCES was effective in reducing average pain intensity compared to sham control (Capel et al. 2003; Tan et al. 2006). Additionally, Capel and colleagues (2003) found significant reducing in use of medications among those in the TCES group compared to control.

Conclusion

There is evidence level 1a evidence (from two RCTs: Capel et al. 2003; Tan et al. 2006) for the benefits of transcranial electrical stimulation in reducing neuropathic and musculoskeletal post-SCI pain.

Transcranial electrical stimulation is effective in reducing post SCI pain.

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