Transcranial DC stimulation coupled with TENS for the treatment of chronic pain : a preliminary study

P.S. Boggio, E.J. Amancio, C.F. Correa, S. Cecilio, C. Valasek, Z. Bajwa, S.D. Freedman, A. Pascual-Leone, Dylan Edwards, F. Fregni

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84 Citations (Scopus)


Objective: Based on evidence showing that electrical stimulation of the nervous system is an effective method to decrease chronic neurogenic pain, we aimed to investigate whether the combination of 2 methods of electrical stimulation-a method of peripheral stimulation [transcutaneous electrical nerve stimulation (TENS)] and a method of noninvasive brain stimulation [transcranial direct current stimulation (tDCS)]-induces greater pain reduction as compared with tDCS alone and sham stimulation.Methods: We performed a preliminary, randomized, sham-controlled, crossover, clinical study in which 8 patients were randomized to receive active tDCS/active TENS (tDCS/TENS group), active tDCS/sham TENS (tDCS group), and sham tDCS/sham TENS (sham group) stimulation. Assessments were performed immediately before and after each condition by a blinded rater.Results: The results showed that there was a significant difference in pain reduction across the conditions of stimulation (P=0.006). Post hoc tests showed significant pain reduction as compared with baseline after the tDCS/TENS condition [reduction by 36.5% (±10.7), P=0.004] and the tDCS condition [reduction by 15.5% (±4.9), P=0.014], but not after sham stimulation (P=0.35). In addition, tDCS/TENS induced greater pain reduction than tDCS (P=0.02).Conclusions: The results of this pilot study suggest that the combination of TENS with tDCS has a superior effect compared with tDCS alone.
Original languageEnglish
Pages (from-to)691-695
JournalThe Clinical Journal of Pain
Issue number8
Publication statusPublished - 2009


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