Effect of Transcranial Direct Current Stimulation of the Motor Cortex on Visceral Pain in Patients with Hepatocellular Carcinoma

• Published in: Pain medicine (Malden, Mass.) Mass.), 2018-03, Vol.19 (3), p.550-560
• Main Authors: Ibrahim, Nagwa Mostafa, Abdelhameed, Khaled Mohamed, Kamal, Shereen Mamdouh Mohamed, Khedr, Eman Mohamed Hussein, Kotb, Hassan Ibrahim Mohamed
• Format: Article
• Language: English
• Subjects: Adult; Aged; Cancer Pain - therapy; Carcinoma, Hepatocellular - complications; Chronic pain; Cortex (motor); Double-Blind Method; Electrical stimulation of the brain; ESB; Female; Hepatocellular carcinoma; Humans; Liver cancer; Liver Neoplasms - complications; Male; Middle Aged; Motor Cortex - physiopathology; Pain; Pain Management - methods; Transcranial Direct Current Stimulation - methods; Visceral Pain - etiology; Visceral Pain - therapy; Visual cortex
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1093/pm/pnx087

Abstract Objective Hepatocellular carcinoma (HCC) is frequently associated with visceral pain. Transcranial direct current stimulation (tDCS) has been proven to reduce chronic pain; however, its effectiveness in malignant visceral pain is unknown. This study aimed to investigate the effects of tDCS in patients with visceral pain due to HCC. Design This is a randomized, sham-controlled, double-blind, prospective study. Forty patients with visceral pain due to HCC were enrolled and randomly assigned into two groups: a real and a sham group; tDCS was applied over the primary motor area (M1) for 10 consecutive days (2 mA, 30 minutes). Patient’s pain was evaluated by visual analog scale (VAS) and verbal descriptor scale (VDS) and for depression by Hamilton rating scale (HAM-D). Evaluation was done at prestimulation, after the first, fifth, and 10th sessions, and one month after the end of stimulation sessions. Results Real tDCS showed a reduction of VDS (P = 0.001, F = 4.01) and VAS (P = 0.001, F = 6.817) for HAM-D (P = 0.012, F = 5,077); the effect started from the fifth session and continued to one month after stimulation, while in the sham group the effect persisted for five days only. Percentage reduction in all scales in the real group after the 10th session was as follows: VDS P = 0.008, VAS P = 0.001, HAM-D = 0.001; for one month after the end of stimulation, it was as follows: VDS P = 0.001, VAS P = 0.037, HAM-D = 0.002. Conclusions tDCS proved to be an effective and clinically relevant therapeutic strategy for visceral pain due to HCC.