Combining TENS and tDCS to relieve persistent pain in a patient suffering
from complex regional pain syndrome: a case report
Tremblay Labrecque, P-F., Lamarche, F., Lefebvre, A., Ostiguy, M., Alie, S., Harvey, M-P., Houde, F., Goffaux, P., Léonard, G.
École de réadaptation, Université de Sherbrooke, Sherbrooke (Québec), Canada
INTRODUCTION
 Complex regional pain syndrome (CRPS) is a neuropathic pain condition characterized by sensory, motor and autonomic
alterations.1
 Past studies have shown that transcranial direct current stimulation (tDCS) and transcutaneous
electrical nerve stimulation (TENS) can alleviate pain in various patient populations.2,3
 A recent study in chronic low back pain patients suggest that a combination of tDCS and TENS
4
can be more effective than either intervention applied alone.
OBJECTIVE
To determine if transcranial direct current stimulation (tDCS), alone or in combination with TENS,
could be a valuable option for relieving persistent pain in a patient suffering from chronic CRPS.
Outcome measures
METHOD
 Visual analog scale (VAS): pain intensity and unpleasantness before,
immediately after and 15 min after each treatment session
 Pain logbooks: daily pain levels completed before, during and after
treatment using numerical pain rating scales (NRS)
 Case report
Patient
‒ 32 year old woman suffering from CRPS type 1 for
more than 3 years in her left lower limb
‒ Continued to report moderate to severe pain despite
medication (pregabalin, tapentadol, duloxetine),
rehabilitation treatments (sensorimotor retraining,
graded motor imagery, home use of TENS) and spinal
cord stimulation
RESULTS
Interventions
1)
2)
tDCS for 5 consecutive days
tDCS + low-frequency TENS for 5 consecutive days
6 months interval
tDCS + low-frequency TENS for 5 consecutive days
3)
Pain intensity
(NRS, mean of days)
Figure 1. Pain levels measured by the pain logbook
10
8
1st treatment session
2nd treatment session
6
Pretreatment
5.9 / 10
4
2
tDCS
5.8 / 10
0
1
78
tDCS +
TENS
Posttx
5 / 10
5/10
12 15
19 20
Pretreatment
7.4 / 10
tDCS +
TENS
Posttreatment
4.6 / 10
4.6 / 10
21
1
78
12 13
21
Time (days)
Figure 2. Pain intensity before and after each treatment session
1st treatment session
Figure 3. Pain unpleasantness before and after each treatment session
2nd treatment session
1st treatment session
8
Pain unpleasantness (VAS)
8
Pain intensity (VAS)
2nd treatment session
7
6
5
4
3
2
1
2
3
4
5
6
7
8
9
Treatment day
10
11
12
13
14
15
7
6
Before treatment
5
After treatment
15 min post-treatment
4
3
2
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Treatment day
CONCLUSION
 Combining TENS and tDCS appears to be a promising strategy for patients suffering from long-standing CRPS pain.
 The nature of the research design (in particular the potential confounding effect of sequence order and the absence of a
placebo condition) prevents us from drawing strong conclusions.
 Future studies are necessary to determine if the results obtained can be replicated using a larger pool of patients.
REFERENCES [1] Harden et al. (2010). Pain, 150. [2] Bélanger (2010). Therapeutic electrophysical agents (2nd ed.). [3] Boggio, P. S., et al. (2008). Eur J Neurol, 15. [4] Schabrun et al. (2014). Brain Stim, 1.