Our Atlanta pain clinic medical doctors are first to offer tDCS
Watch the CBS News story about tDCS
Our Atlanta pain doctors have a new technology — tDCS — to treat pain that doesn’t respond to other pain treatments. It is ideal for many patients suffering from chronic pain because it is effective, inexpensive, painless, non-invasive, non-surgical and requires only 20-minute treatments.
Our Atlanta doctors use tDCS to treat patients suffering from chronic pain, fibromyalgia pain, pain from stroke, migraine headache pain, back pain, neck pain, face pain, spinal cord pain, trigeminal neuralgia, complex regional pain syndrome, phantom-limb pain, pain of depression and neuropathic pain.
tDCS also relieves the symptoms of narcotic withdrawal and reduces craving for drugs including nicotine and alcohol.
tDCS works (see the medical references at the end of this article.) 60-70% of patients with treatment-resistant chronic pain find relief using transcranial direct current stimulation treatments. tDCS reduces depression scores 40-60% in 5-10 days and reduces treatment-resistant scores 30% in 5 days. tDCS improves memory and motor function in stroke patients. tDCS patients often experience better sleep, increased physical activity, and they require less medications.
How transcranial direct current stimulation works
tDCS treatment is painless
The patient needing pain relief sits or reclines in a comfortable position and the medical doctor painlessly attaches two 2-inch electrodes to the outside of the skull. The procedure is painless. Patients may notice a mild tingling or itching on the skin under the electrodes. The sensation disappears at the end of stimulation.
For twenty minutes, a current so low the patient cannot feel it is sent through the electrodes to treat specific areas of the pain related to the patient’s pain and condition. The weak current stimulates activity of neurons in the brain. Brain tissues below the positive electrode becomes excited and brain tissue below the negative electrode becomes less excited.
tDCS is not electroconvulsive therapy
Please don’t confuse tDCS with ECT (electroconvulsive therapy.) tDCS doesn’t produce unwanted effects like seizures or muscle twitches that happen with old forms of electrical stimulation. ECT uses strong electric currents under general anesthesia. tDCS uses low power administered while the patient is conscious and awake. The doctor uses a stimulator that is powered by a 9-volt battery. This low current cannot be felt by the patient while receiving the pain relief. It is a painless treatment for chronic pain.
No side effects have been associated with tDCS pain relief treatments, unlike pain relief drugs which can have numerous side effects.
Questions about pain relief with tDCS
What is tDCS?
tDCS is a new therapy utilizing a direct electrical current so low that it cannot be felt. It is passed through the skull and into the brain below. Specifically, the current may reverse the abnormal brain excitability responsible for pain, depression and drug craving. tDCS also improves recovery from stroke.
Who can be helped by tDCS?
tDCS studies demonstrate pain relief for chronic pain syndromes including Fibromyalgia and neuropathic pain; improvement of treatment-resistant depression; reduction of drug craving, including nicotine and alcohol; and improved recovery from stroke.
How is tDCS done?
Either sitting or lying down, whichever is more comfortable, 2 electrodes are placed on specific locations of the scalp. The stimulation is painless, lasts 20-30 minutes and is repeated for a total of 5-10 treatments.
Is tDCS reimbursed by insurance companies?
No, insurance companies, Medicaid and Medicare do not reimburse for this treatment. The individual patient is charged for the procedure but the cost is very affordable.
Will I have to stop my pain medications?
No, pain medications can be continued throughout the tDCS treatment protocol.
Is tDCS safe?
Thousands of patients have been treated with tDCS and no side effects have been reported to date.
What is the evidence that tDCS works?
Numerous clinical studies of tDCS have been conducted. tDCS can help patients with chronic pain syndromes, including Fibromyalgia and neuropathic pain; treatment-resistant depression; craving for drugs, including nicotine and alcohol; and recovery from stroke. Abstracts of all the studies utilizing tDCS can be found on the following website: www.ncbi.nlm.nih.gov/PubMed, a service of the United States National Library of Medicine and the National Institutes of Health.
What specific kinds of pain can tDCS treat?
Chronic pain, fibromyalgia pain, pain from stroke, arthritis pain, migraine headache pain, back pain, neck pain, shoulder pain, knee pain, hip pain, carpal tunnel syndrome pain, pain of depression, neuropathic pain, myofascial pain, herniated disc pain, sciatica pain, tendonitis pain, bursitis pain, pinched nerve pain, sacroiliac joint pain, and pain from shingles.
References about transcranial direct current stimulation
References: Effects of tDCS on Pain
“There is clear evidence that tDCS can reduce pain and modify neurophysiologic correlates of the pain experience.”
Noninvasive transcranial brain stimulation and pain. Rosen AC, Ramkumar M, Nguyen T, Hoeft F. Curr Pain Headache Rep. 2009 Feb;13(1):12-7.
“We report a case of severe, medically refractory vulvodynia that responded remarkably to treatment with transcranial direct current stimulation.”
Exploring a novel therapeutic approach with noninvasive cortical stimulation for vulvodynia. Cecilio SB, Zaghi S, Cecilio LB, Correa CF, Fregni F. Am J Obstet Gynecol. 2008 Dec;199(6):e6-7.
“tDCS produced a 50% reduction of fibromyalgia pain (after five 20-minute treatments).”
A randomized, sham-controlled, proof of principle study of transcranial direct current stimulation for the treatment of pain in fibromyalgia. Fregni F, Gimenes R, Valle AC, Ferreira MJ, Rocha RR, Natalle L, Bravo R, Rigonatti SP, Freedman SD, Nitsche MA, Pascual-Leone A, Boggio PS. Arthritis Rheum. 2006 Dec;54(12):3988-98.
“There was a significant pain improvement after tDCS stimulation of the motor cortex.”
A sham-controlled, phase II trial of transcranial direct current stimulation for the treatment of central pain in traumatic spinal cord injury. Fregni F, Boggio PS, Lima MC, Ferreira MJ, Wagner T, Rigonatti SP, Castro AW, Souza DR, Riberto M, Freedman SD, Nitsche MA, Pascual-Leone A. Pain. 2006 May;122(1-2):197-209
References: Effects of tDCS on Depression
“Overall depression scores improved significantly over ten 20-minute tDCS treatments. tDCS was found to be safe, with no adverse effects on neuropsychological function, and only minor side-effects.”
A double-blind, sham-controlled trial of transcranial direct current stimulation for the treatment of depression. Loo CK, Sachdev P, Martin D, Pigot M, Alonzo A, Malhi GS, Lagopoulos J, Mitchell P. Int J Neuropsychopharmacol. 2009 Aug 12:1-9.
“In fact, two recent trials have shown that tDCS is associated with significant clinical gains.”
Transcranial direct current stimulation as a therapeutic tool for the treatment of major depression: insights from past and recent clinical studies. Murphy DN, Boggio P, Fregni F. Curr Opin Psychiatry. 2009 May;22(3):306-11. Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School.
“After five days of treatment (40 minutes of treatment each day) depression scores improved more than 30%. The mood improvement persisted and even increased at four weeks after treatment ended. The feeling of sadness and mood improved after tDCS. We conclude that frontal tDCS is a simple technique that can be considered in clinical practice as adjuvant treatment for patients with severe, drug-resistant major depression.”
Transcranial direct current stimulation in severe, drug-resistant major depression. Ferrucci R, Bortolomasi M, Vergari M, Tadini L, Salvoro B, Giacopuzzi M, Barbieri S, Priori A. J Affect Disord. 2009 Nov;118(1-3):215-9.
“The treatment was well tolerated with minimal side-effects. We found reductions in depression scores after tDCS of 40.4%. The beneficial effects of tDCS persisted for 1 month after the end of treatment.”
A randomized, double-blind clinical trial on the efficacy of cortical direct current stimulation for the treatment of major depression. Boggio PS, Rigonatti SP, Ribeiro RB, Myczkowski ML, Nitsche MA, Pascual-Leone A, Fregni F. Int J Neuropsychopharmacol. 2008 Mar;11(2):249-54.
“The mechanism of tDCS in modulating emotional pain involve pathways that are independent of those modulating the somatosensory perception of pain.”
Modulation of emotions associated with images of human pain using anodal transcranial direct current stimulation (tDCS). Boggio PS, Zaghi S, Fregni F. Neuropsychologia. 2009 Jan;47(1):212-7.
References: Effects of tDCS on stroke
“Transcranial direct current stimulation over the left dorsolateral prefrontal cortex was associated with enhanced working memory performance as indexed by the recognition accuracy in patients after a stroke.” Enhancing the working memory of stroke patients using tDCS. Jo JM, Kim YH, Ko MH, Ohn SH, Joen B, Lee KH. Am J Phys Med Rehabil. 2009 May;88(5):404-9.
“Modulation of cortical excitability may instantaneously induce plastic changes within the cortical network of sensorimotor areas, thereby improving motor function of the affected hand after stroke.” Interhemispheric competition after stroke: brain stimulation to enhance recovery of function of the affected hand. Nowak DA, Grefkes C, Ameli M, Fink GR. Neurorehabil Neural Repair. 2009 Sep;23(7):641-56.
“The evidence supports that tDCS has a therapeutic value in different neurological conditions.” Updates on the use of non-invasive brain stimulation in physical and rehabilitation medicine. Williams JA, Imamura M, Fregni F. J Rehabil Med. 2009 Apr;41(5):305-11. Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
“We review tDCS’s successful utilization in pilot and proof-of-principle stroke recovery studies.” Transcranial direct current stimulation: a noninvasive tool to facilitate stroke recovery. Schlaug G, Renga V. Expert Rev Med Devices. 2008 Nov;5(6):759-68.
“tDCS significantly improved the accuracy of the picture naming task by a mean of 33.6% in eight chronic non-fluent post-stroke aphasic patients.” Improved naming after transcranial direct current stimulation in aphasia. Monti A, Cogiamanian F, Marceglia S, Ferrucci R, Mameli F, Mrakic-Sposta S, Vergari M, Zago S, Priori A. J Neurol Neurosurg Psychiatry. 2008 Apr;79(4):451-3.
“The findings of our study support previous research showing that tDCS is significantly associated with motor function improvement in stroke patients; and support that consecutive, daily sessions of tDCS increase its behavioral effects. The technique of tDCS is simple, safe and non-expensive.” Repeated sessions of noninvasive brain DC stimulation is associated with motor function improvement in stroke patients. Boggio PS, Nunes A, Rigonatti SP, Nitsche MA, Pascual-Leone A, Fregni F. Restor Neurol Neurosci. 2007;25(2):123-9.