• Paulo S Boggio, Edson J Amancio, Claudio F Correa, Sofia Cecilio, Claudia Valasek, Zahid Bajwa, Steven D Freedman, Alvaro Pascual-Leone, Dylan J Edwards, and Felipe Fregni.
• Núcleo de Neurociências, Centro de Ciências Biológicas e da Saúde, Universidade Presbiteriana Mackenzie, Sao Paulo, Brazil.
• Clin J Pain. 2009 Oct 1; 25 (8): 691-5.

ObjectiveBased 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.MethodsWe 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.ResultsThe 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).ConclusionsThe results of this pilot study suggest that the combination of TENS with tDCS has a superior effect compared with tDCS alone.

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