TY - JOUR
T1 - Effects of combining a brief cognitive intervention with transcranial direct current stimulation on pain tolerance
T2 - A randomized controlled pilot study
AU - Powers, Abigail
AU - Madan, Alok
AU - Hilbert, Megan
AU - Reeves, Scott T.
AU - George, Mark
AU - Nash, Michael R.
AU - Borckardt, Jeffrey J.
N1 - Funding Information:
Funding sources: This research was partially supported by the Menninger Clinic Foundation and McNair Medical Institute. Dr. Madan is a McNair Scholar. The study follows the guidelines on good publication practices. The study sponsors were not involved in any aspect of the research activities and did not approve the specific protocol or manuscript. Thus, the authors were independent from study sponsors in the context of the research.
Publisher Copyright:
© 2018 Oxford University Press. All rights reserved.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2018/4/1
Y1 - 2018/4/1
N2 - Objective. Cognitive behavioral therapy has been shown to be effective for treating chronic pain, and a growing literature shows the potential analgesic effects of minimally invasive brain stimulation. However, few studies have systematically investigated the potential benefits associated with combining approaches. The goal of this pilot laboratory study was to investigate the combination of a brief cognitive restructuring intervention and transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex in affecting pain tolerance. Design. Randomized, double-blind, placebo-controlled laboratory pilot. Setting. Medical University of South Carolina. Subjects. A total of 79 healthy adult volunteers. Methods. Subjects were randomized into one of six groups: 1) anodal tDCS plus a brief cognitive intervention (BCI); 2) anodal tDCS plus pain education; 3) cathodal tDCS plus BCI; 4) cathodal tDCS plus pain education; 5) sham tDCS plus BCI; and 6) sham tDCS plus pain education. Participants underwent thermal pain tolerance testing pre-And postintervention using the Method of Limits. Results. A significant main effect for time (pre-post intervention) was found, as well as for baseline thermal pain tolerance (covariate) in the model. A significant time 3 group interaction effect was found on thermal pain tolerance. Each of the five groups that received at least one active intervention outperformed the group receiving sham tDCS and pain education only (i.e., control group), with the exception of the anodal tDCS1education-only group. Cathodal tDCS combined with the BCI produced the largest analgesic effect. Conclusions. Combining cathodal tDCS with BCI yielded the largest analgesic effect of all the conditions tested. Future research might find stronger interactive effects of combined tDCS and a cognitive intervention with larger doses of each intervention. Because this controlled laboratory pilot employed an acute pain analogue and the cognitive intervention did not authentically represent cognitive behavioral therapy per se, the implications of the findings on chronic pain management remain unclear.
AB - Objective. Cognitive behavioral therapy has been shown to be effective for treating chronic pain, and a growing literature shows the potential analgesic effects of minimally invasive brain stimulation. However, few studies have systematically investigated the potential benefits associated with combining approaches. The goal of this pilot laboratory study was to investigate the combination of a brief cognitive restructuring intervention and transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex in affecting pain tolerance. Design. Randomized, double-blind, placebo-controlled laboratory pilot. Setting. Medical University of South Carolina. Subjects. A total of 79 healthy adult volunteers. Methods. Subjects were randomized into one of six groups: 1) anodal tDCS plus a brief cognitive intervention (BCI); 2) anodal tDCS plus pain education; 3) cathodal tDCS plus BCI; 4) cathodal tDCS plus pain education; 5) sham tDCS plus BCI; and 6) sham tDCS plus pain education. Participants underwent thermal pain tolerance testing pre-And postintervention using the Method of Limits. Results. A significant main effect for time (pre-post intervention) was found, as well as for baseline thermal pain tolerance (covariate) in the model. A significant time 3 group interaction effect was found on thermal pain tolerance. Each of the five groups that received at least one active intervention outperformed the group receiving sham tDCS and pain education only (i.e., control group), with the exception of the anodal tDCS1education-only group. Cathodal tDCS combined with the BCI produced the largest analgesic effect. Conclusions. Combining cathodal tDCS with BCI yielded the largest analgesic effect of all the conditions tested. Future research might find stronger interactive effects of combined tDCS and a cognitive intervention with larger doses of each intervention. Because this controlled laboratory pilot employed an acute pain analogue and the cognitive intervention did not authentically represent cognitive behavioral therapy per se, the implications of the findings on chronic pain management remain unclear.
KW - Cognitive Behavioral Therapy
KW - Thermal Pain Tolerance
KW - Transcranial Direct Current Stimulation
UR - http://www.scopus.com/inward/record.url?scp=85052703843&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85052703843&partnerID=8YFLogxK
U2 - 10.1093/pm/pnx098
DO - 10.1093/pm/pnx098
M3 - Article
C2 - 28460127
AN - SCOPUS:85052703843
VL - 19
SP - 677
EP - 685
JO - Pain Medicine
JF - Pain Medicine
SN - 1526-2375
IS - 4
ER -