Chronic pain is pain that lasts beyond expected healing. Many patients experience continuing pain despite conventional treatments such as medication, physical therapy, injections, and even surgery.
If you are suffering from this refractory type of chronic pain, neuromodulation therapies such as Transcranial Direct Current Stimulation (tDCS) may be an option.
tDCS is a type of Neuromodulation therapy designed to alter the way the nervous system (nerves, spinal cord, and/or brain) transmits messages that occur when pain nerve cells are stimulated or damaged.
Other types of neuromodulation include spinal cord stimulation for refractory pain, and transcranial magnetic stimulation or TMS, an FDA-approved treatment for depression that is currently being evaluated for the treatment of chronic pain.
Physicians believe that chronic pain occurs when there is an imbalance in nerve cell activity and neurotransmitters (chemical messengers between nerve cell.) There is still a pain signal in the brain despite resolution of an initial injury or illness. Think of it as a short-circuit or computer virus. Neuromodulation may adjust these imbalances and give patients relief from these pain.
tDCS is a unique, safe option for trying to alleviate chronic pain. tDCS trials that have shown success include RSD (Complex Regional Pain Syndrome), fibromyalgia, neuropathic (nerve damage) pain, migraines, depression, and pain after brain damage or stroke. In tDCS, a low level electrical current (so low that it cannot be felt during most of the treatment), is passed through the skull to the brain below. The mechanism of tDCS is not clear, but studies have shown that the current affects a variety of brain areas. TDCS polarizes (gives a relative negative or positive electrical charge) to the brain cells under the electrode, and reduces or enhances the tendency of the brain cells to trigger an electrical message. This polarization may reverse the abnormal brain excitability responsible for pain.
tDCS is a short and painless procedure. Two small electrodes are placed on your scalp with wires attached. A constant-current electrical stimulator with about as much voltage as a 9 volt battery is applied for approximately 20 minutes.
Patients may feel slight itching of the scalp. The stimulation is repeated for several consecutive days, and sometimes up to several weeks depending on patient response.
Frequently Asked Questions
Preliminary data suggest that patients with a variety of pain syndromes, including:
- neuropathic pain
It has also been used for mood disorders and stroke rehabilitation.
It is a short, painless procedure. While you rest in a comfortable chair or exam table, two 2x2 or 2x4 inch electrodes are placed on your scalp with wires attached.
A constant-current electrical stimulator with about as much voltage as a 9-volt battery is applied for approximately 20 minutes. A slight itching sensation is sometimes felt breifly in the scalp.
The stimulation will be repeated for several consecutive days or sometimes up to several weeks depending on patient response.
You will be responsible for payment for tDCS at the time of service. A discount is given for several treatments paid in advance.
Since there is no specific procedure billing code for this new treatment, it is not yet covered by most insurance plans.
If you wish to try to get reimbursed by your insurance company, we will provide you with documentation.
There is early evidence that tDCS can help some patients with certain types of neuropathic pain. Numerous medical journal articles have evaluated the effect of tDCS in humans.
It has also been utilized successfully to treat a selected group of patients with migraines, fibromyalgia, depression and Parkinson’s disease.
Many patients have been treated with this procedure and no serious side effects have been reported to date. Very brief scalp itching may occur. Scalp irritation at the site of the electrodes can occur. On a few occasions, small, surface scalp burns have been reported.
There is little information about long-term outcome with this treatment. However, tDCS has been tested in thousands of subjects worldwide with no evidence of toxic effects to date, including studies which monitored cognitive (thinking) functions of the brain.
Brunoni et al, Brain Stimulation (2012) 5, 175–95