Using Home-based, Remotely Supervised, Transcranial Direct Current Stimulation for Phantom Limb Pain

Kevin Pacheco-Barrios; Daniela Martinez-Magallanes; Cristina Xicota Naqui; Marianna Daibes; Elly Pichardo; Alejandra Cardenas-Rojas; David Crandell; Anahita Dua; Abhishek Datta; Wolnei Caumo; Felipe Fregni

doi:10.3791/66006

Uso de la estimulación transcraneal de corriente continua supervisada a distancia en el hogar par...

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JoVE Journal Neuroscience

Using Home-based, Remotely Supervised, Transcranial Direct Current Stimulation for Phantom Limb Pain

Uso de la estimulación transcraneal de corriente continua supervisada a distancia en el hogar para el dolor del miembro fantasma

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06:13 min

March 1, 2024

DOI: 10.3791/66006-v

Kevin Pacheco-Barrios*^1,2, Daniela Martinez-Magallanes*¹, Cristina Xicota Naqui^1,3, Marianna Daibes¹, Elly Pichardo¹, Alejandra Cardenas-Rojas¹, David Crandell⁴, Anahita Dua⁵, Abhishek Datta^6,7, Wolnei Caumo^8,9,10, Felipe Fregni¹

¹Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital,Massachusetts General Hospital, Harvard Medical School, ²Vicerrectorado de Investigación,Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, ³Nursing Department,Universitat Internacional de Catalunya, ⁴Spaulding Rehabilitation Hospital,Harvard Medical School, ⁵Division of Vascular and Endovascular Surgery,Massachusetts General Hospital, Harvard Medical School, ⁶Research and Development,Soterix Medical, ⁷City College of New York, ⁸Post-Graduate Program in Medical Sciences, School of Medicine,Universidade Federal do Rio Grande do Sul (UFRGS), ⁹Laboratory of Pain & Neuromodulation,Hospital de Clinicas de Porto Alegre (HCPA), ¹⁰Pain and Palliative Care Service,Hospital de Clinicas de Porto Alegre (HCPA)

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Overview

This study outlines a protocol for the home-based delivery of remotely supervised transcranial direct current stimulation (RS-tDCS) aimed at treating patients with phantom limb pain (PLP). The protocol conserves in-clinic practices related to safety and tolerability, while also addressing logistical challenges associated with remote applications.

Key Study Components

Area of Science

Neuroscience
Neuromodulation
Chronic Pain Management

Background

Transcranial direct current stimulation (tDCS) has shown positive results for treating chronic pain.
Recent studies indicate sustained pain reduction through combined stimulation techniques.
Practical guidance for implementing RS-tDCS in clinical trials is limited.
The findings could be applicable to other conditions such as Parkinson's disease and post-stroke rehabilitation.

Purpose of Study

To develop a clear visual guideline for RS-tDCS protocols.
To address practical details and challenges in home-based implementations.
To enhance clinical application of neuromodulation in rehabilitation settings.

Methods Used

The study will utilize RS-tDCS protocols with a focus on patient populations experiencing PLP.
Logistical challenges and methodologies for remote supervision are key components of this trial.
No specific multiomics workflows are mentioned, as the focus is on tDCS.
Implementation details will include patient safety and reproducibility.

Main Results

Participants are expected to experience significant pain relief during and after the intervention.
The study aims to validate RS-tDCS as a practical solution for chronic pain treatment.
Long-term follow-up will assess the sustainability of pain relief.
Conclusions will help inform broader applications of neuromodulation techniques.

Conclusions

This study demonstrates the feasibility of remote neuromodulation for coping with chronic pain.
The implementation insights could improve the delivery of home-based therapies.
Findings may contribute to better understanding of neuronal mechanisms in pain management.

Frequently Asked Questions

What are the advantages of RS-tDCS?

RS-tDCS allows for remote treatment of patients, increasing accessibility and convenience while maintaining safety and effectiveness as in-clinic applications.

How is the biological model of PLP implemented?

Patients with phantom limb pain will participate in the protocol, receiving RS-tDCS as an intervention to assess its efficacy on pain relief.

What types of outcomes can be obtained with this method?

Outcomes include pain relief assessments, evaluations of treatment tolerability, and follow-up studies to measure sustained effects.

How can the RS-tDCS method be adapted for other conditions?

The insights gained from this study can be translated to applications in other populations, such as those with Parkinson's disease and post-stroke rehabilitation.

What are the key limitations to consider?

Limitations include the potential variability in patient adherence, the need for supervision, and challenges associated with remote healthcare delivery.

How will this study improve future neuromodulation techniques?

The findings aim to enhance the methodologies for home-based neuromodulation, potentially increasing its clinical use and acceptance in chronic pain treatment.

El objetivo de este estudio es describir un protocolo para la administración domiciliaria de estimulación transcraneal de corriente continua supervisada a distancia (RS-tDCS) conservando los procedimientos estándar de la práctica clínica, incluida la seguridad, la reproducibilidad y la tolerabilidad. Los participantes incluidos serán pacientes con dolor del miembro fantasma (PLP).

De todos los tratamientos disponibles, estudios recientes que utilizan la estimulación transcraneal de corriente continua, tDCS, han reportado resultados positivos al combinar la estimulación de la corteza motora primaria, M1, con técnicas de representación motora. Los efectos a largo plazo de la estimulación combinada dieron lugar a una reducción significativa y sostenida del dolor después de la intervención y un período de seguimiento de tres meses. Nuestro objetivo es proporcionar una guía visual sobre cómo realizar una sesión de tDCS supervisada a distancia, así como una descripción de la logística y los desafíos de su implementación para el tratamiento del dolor del miembro fantasma, especialmente en el contexto de un ensayo clínico pragmático.

Otra contribución importante de este protocolo es que la mayoría de los conocimientos que proporcionamos aquí se pueden trasladar a otras poblaciones estudiadas, como la enfermedad de Parkinson, las lesiones cerebrales traumáticas y la rehabilitación posterior a un accidente cerebrovascular. Los detalles prácticos y la orientación sobre cómo implementar la RS-tDCS para los ensayos clínicos sobre el dolor crónico aún son limitados en la literatura, y tienen el potencial de acelerar la aplicación clínica de la intervención segura y eficaz. Y así sucesivamente, facilitar su combinación con las modalidades conductuales que se pueden realizar en casa.

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