Stroke patients frequently suffer from chronic limb pain, but well-suited treatment
approaches have been not established so far. Transcranial direct current stimulation
(tDCS) is a safe and non-invasive brain stimulation technique that alters cortical excitability,
and it has been shown that motor cortex tDCS can reduce pain. Some data also suggest
that spasticity may be improved by tDCS in post-stroke patients. Moreover, multiple
sessions of tDCS have shown to induce neuroplastic changeswith lasting beneficial effects
in different neurological conditions. The aim of this pilot study was to explore the effect of
multiple anodal tDCS (atDCS) sessions on upper limb pain and spasticity of stroke
patients, using a within-subject, crossover, sham-controlled design. Brain damage was
of similar extent in the three patients evaluated, although located in different hemispheres.
The results showed a significant effect of 5 consecutive sessions of atDCS, compared to
sham stimulation, on pain evaluated by the Adaptive Visual Analog Scales -AVAS-, and
spasticity evaluated by the Fugl-Meyer scale. In two of the patients, pain was completely
relieved and markedly reduced, respectively, only after verum tDCS. The pain
improvement effect of atDCS in the third patient was considerably lower compared to
the other two patients. Spasticity was significantly improved in one of the patients. The
treatment was well-tolerated, and no serious adverse effects were reported. These
findings suggest that multiple sessions of atDCS are a safe intervention for improving
upper limb pain and spasticity in stroke patients, although the inter-individual variability is a
limitation of the results. Further studies including longer follow-up periods, more
representative patient samples and individualized stimulation protocols are required to
demonstrate the efficacy and safety of tDCS for improving limb symptoms in these
patients.
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