• Laura Castillo-Saavedra, Nigel Gebodh, Marom Bikson, Camilo Diaz-Cruz, Rivail Brandao, Livia Coutinho, Dennis Truong, Abhishek Datta, Revital Shani-Hershkovich, Michal Weiss, Ilan Laufer, Amit Reches, Ziv Peremen, Amir Geva, Lucas C Parra, and Felipe Fregni.
• Laboratory of Neuromodulation, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
• J Pain. 2016 Jan 1; 17 (1): 142614-26.

UnlabelledDespite promising preliminary results in treating fibromyalgia (FM) pain, no neuromodulation technique has been adopted in clinical practice because of limited efficacy, low response rate, or poor tolerability. This phase II open-label trial aims to define a methodology for a clinically effective treatment of pain in FM by establishing treatment protocols and screening procedures to maximize efficacy and response rate. High-definition transcranial direct current stimulation (HD-tDCS) provides targeted subthreshold brain stimulation, combining tolerability with specificity. We aimed to establish the number of HD-tDCS sessions required to achieve a 50% FM pain reduction, and to characterize the biometrics of the response, including brain network activation pain scores of contact heat-evoked potentials. We report a clinically significant benefit of a 50% pain reduction in half (n = 7) of the patients (N = 14), with responders and nonresponders alike benefiting from a cumulative effect of treatment, reflected in significant pain reduction (P = .035) as well as improved quality of life (P = .001) over time. We also report an aggregate 6-week response rate of 50% of patients and estimate 15 as the median number of HD-tDCS sessions to reach clinically meaningful outcomes. The methodology for a pivotal FM neuromodulation clinical trial with individualized treatment is thus supported.Online RegistrationRegistered in Clinicaltrials.gov under registry number NCT01842009.PerspectiveIn this article, an optimized protocol for the treatment of fibromyalgia pain with targeted subthreshold brain stimulation using high-definition transcranial direct current stimulation is outlined.Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

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