Home-based transcranial direct current stimulation for persistent pain state in rheumatoid arthritis: a randomized...

Area of Science:

• Neurology
• Rheumatology
• Pain Management

Background:

• Rheumatoid arthritis (RA) often involves persistent pain despite inflammation control, linked to central sensitization and neuroinflammation.
• Home-based transcranial direct current stimulation (tDCS) has emerged as a potential therapy for chronic pain conditions.

Purpose of the Study:

• To evaluate the efficacy of anodal tDCS (a-tDCS) compared to sham stimulation in alleviating pain in RA patients.
• To assess the impact of a-tDCS on pain reduction, physical function, and analgesic use.

Main Methods:

• A randomized, double-blind, sham-controlled trial involving 34 women with RA and significant pain (VAS > 40 mm).
• Participants received either home-based a-tDCS or sham tDCS (2 mA, 20 min/day) for four weeks using an anodal-left M1 montage.
• Primary outcome was pain reduction (VAS); secondary outcomes included physical function (HAQ-DI), central sensitization, fatigue, and analgesic use.

Main Results:

• The a-tDCS group showed a significantly greater reduction in VAS pain (-33.5 mm) compared to the sham group (-14.1 mm), with a between-group difference of -19.4 mm (p=0.003).
• a-tDCS led to a 27.7% reduction in VAS pain versus 6.0% with sham, and a 38.0% improvement in HAQ-DI versus 7.2% with sham.
• Analgesic use decreased by 62% in the a-tDCS group, suggesting reduced reliance on pain medication.

Conclusions:

• Home-based a-tDCS is an effective treatment for reducing pain and disability in RA patients experiencing persistent pain.
• The findings suggest that a-tDCS may modulate neuroplasticity mechanisms contributing to pain relief.
• This non-pharmacological intervention offers a viable alternative for managing chronic pain in RA, even in the absence of active inflammation.