Non-Invasive Brain Stimulation for the Treatment of Parkinson´s Disease-related Pain
Non-Invasive Brain Stimulation Targeting Pain in Parkinson´s Disease Patients: A Randomized Controlled Trial
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Madrid, Spain, 28007
- Hospital Beata Maria Ana
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Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Neuroimaging study without previous pathologies.
- Score > 5 in transfers (bed to chair and back) item in Barthel Index.
- Score = or > 24 in Mini-Mental State Examination.
- Tolerability for the application of electrotherapy.
- Able to provide informed consent to participate in the study.
Exclusion Criteria:
- Neurologic disease different from PD.
- Pain non-related to PD.
- Dermatologic problems, wounds, or ulcers in the electrode's application area.
- Presence of implants or metal pieces in the head.
- Presence of cardiac pacemaker, vagal, brain or transcutaneous stimulators, medication pumps, ventriculoperitoneal shunts or aneurysm clips.
- Significative difficulties in language.
- History of alcohol or drugs abuse.
- Non-controlled medical problems.
- Pregnancy.
- Epilepsy.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
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Experimental: Active Transcranial Direct Current Stimulation
Active Transcranial Direct Current Stimulation (a-tDCS) will be applied over the Primary Motor Cortex during 10 sessions of 20 minutes at 2 milli amps.
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The Starstim tDCS® stimulator will be used by an experienced physical therapist to transfer direct current by a saline-soak pair of surface sponge electrodes (35cm2).
The anode electrode will be placed over C3 (EEG 10/20 system) and the cathode electrode over the contralateral supraorbital area (Fp2), in order to enhance the excitability of M1 (32).
Regarding the stimulated hemisphere, contralateral M1 will be stimulated in patients with asymmetric pain and the dominant (contrary to the dominant hand determined by the Edinburgh Handedness Inventory) in patients with symmetric pain, due to the widespread changes induced by tDCS in other cortical areas, including contralateral M1.
A constant current of 2 milli amps intensity (subthreshold intensity) will be applied for 20 min, with 30 seconds of ramp-up and 30 seconds of ramp-down.
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Sham Comparator: Sham Transcranial Direct Current Stimulation
Sham Transcranial Direct Current (s-tDCS) will be applied over the Primary Motor Cortex during 10 sessions of 20 minutes.
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The electrodes will be placed in the same positions as for M1 stimulation, but only applying ramping active current for 30 seconds in the beginning and at the end of the procedure for a reliable blinding.
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Change in King´s Parkinson´s Disease Pain Scale score
Time Frame: From Baseline at 2 weeks
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Parkinson´s Disease specific scale that evaluates the localization, frequency, and intensity of pain.
It has 14 items distributed in 7 domains: 1. Musculoskeletal Pain; 2. Chronic Pain; 3. Fluctuation-related Pain; 4. Nocturnal Pain; 5. Oro-facial Pain; 6. Discoloration, Oedema/Swelling Pain; 7. Radicular Pain.
Each item is scored by severity (0, none to 3, very severe) multiplied by frequency (0, never to 4, all the time) resulting in a subscore of 0 to 12, the sum of which gives the total score with a theoretical range from 0 to 168, with higher scores indicating more severity and frequency of pain.
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From Baseline at 2 weeks
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Change in King´s Parkinson´s Disease Pain Scale score
Time Frame: From Baseline at 1 month
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Parkinson´s Disease specific scale that evaluates the localization, frequency, and intensity of pain.
It has 14 items distributed in 7 domains: 1. Musculoskeletal Pain; 2. Chronic Pain; 3. Fluctuation-related Pain; 4. Nocturnal Pain; 5. Oro-facial Pain; 6. Discoloration, Oedema/Swelling Pain; 7. Radicular Pain.
Each item is scored by severity (0, none to 3, very severe) multiplied by frequency (0, never to 4, all the time) resulting in a subscore of 0 to 12, the sum of which gives the total score with a theoretical range from 0 to 168, with higher scores indicating more severity and frequency of pain.
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From Baseline at 1 month
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Change in Brief Pain Inventory score
Time Frame: From Baseline at 2 weeks
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It contains 15 items, including 2 multi-item scales to measure the intensity of pain and its impact on the function and welfare of patients.
It also presents open questions to assess the localization of pain and the treatment used for its management, just as its effectiveness.
Scores oscillate from 0 to 110, with higher scores indicating more pain and more impact on function and welfare of patients.
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From Baseline at 2 weeks
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Change in Brief Pain Inventory score
Time Frame: From Baseline at 1 month
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It contains 15 items, including 2 multi-item scales to measure the intensity of pain and its impact on the function and welfare of patients.
It also presents open questions to assess the localization of pain and the treatment used for its management, just as its effectiveness.
Scores oscillate from 0 to 110, with higher scores indicating more pain and more impact on function and welfare of patients.
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From Baseline at 1 month
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Change in Conditioned Pain Modulation
Time Frame: From Baseline at 2 weeks
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Assesses the descending pain modulatory system.
The Pain Pressure Threshold will be assessed in the middle of the distal phalanx of the thumb with ta handheld algometer, corresponding to the first test stimulus.
Afterward, the patient will immerse the contrary hand up to the wrist into stirred ice-cold water (0-4º) maintaining it for 3 minutes, corresponding to the conditioning stimulus.
If the pain is unbearable before the 3 minutes, the patient will be able to remove his/her hand.
Immediately after removing the hand, a second Pain Pressure Threshold measure will be performed in the same place as the first one, corresponding to the second test stimulus.
After 1-minute rest, a third Pain Pressure Threshold will be measured to assess the Conditioned Pain Modulation residual functioning.
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From Baseline at 2 weeks
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Change in Conditioned Pain Modulation
Time Frame: From Baseline at 1 month
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Assesses the descending pain modulatory system.
The Pain Pressure Threshold will be assessed in the middle of the distal phalanx of the thumb with ta handheld algometer, corresponding to the first test stimulus.
Afterward, the patient will immerse the contrary hand up to the wrist into stirred ice-cold water (0-4º) maintaining it for 3 minutes, corresponding to the conditioning stimulus.
If the pain is unbearable before the 3 minutes, the patient will be able to remove his/her hand.
Immediately after removing the hand, a second Pain Pressure Threshold measure will be performed in the same place as the first one, corresponding to the second test stimulus.
After 1-minute rest, a third Pain Pressure Threshold will be measured to assess the Conditioned Pain Modulation residual functioning.
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From Baseline at 1 month
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Change in Temporal Summation
Time Frame: From Baseline at 2 weeks
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Represents excitatory modulation processes.
It will be generated through the application of 10 pulses of the handheld pressure algometer over the middle of the distal phalanx of the thumb with the intensity of the Pain Pressure Threshold, previously calculated.
In each pulse, pressure intensity will be increasing at a rate of 2 kg/s over the previously determined Pain Pressure Threshold intensity, leaving an interstimulus interval of one second according to the optimal method reported for inducing Temporal Summation with pressure pain.
Before the first pressure pulse, subjects were taught to use a verbal numeric pain rating scale to rate the pain intensity of the first, fifth, and 10th pressure pulses.
The verbal numeric pain rating scale ranged from 0 ("no pain") to 10 ("the worst possible pain").
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From Baseline at 2 weeks
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Change in Temporal Summation
Time Frame: From Baseline at 1 month
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Represents excitatory modulation processes.
It will be generated through the application of 10 pulses of the handheld pressure algometer over the middle of the distal phalanx of the thumb with the intensity of the Pain Pressure Threshold, previously calculated.
In each pulse, pressure intensity will be increasing at a rate of 2 kg/s over the previously determined Pain Pressure Threshold intensity, leaving an interstimulus interval of one second according to the optimal method reported for inducing Temporal Summation with pressure pain.
Before the first pressure pulse, subjects were taught to use a verbal numeric pain rating scale to rate the pain intensity of the first, fifth, and 10th pressure pulses.
The verbal numeric pain rating scale ranged from 0 ("no pain") to 10 ("the worst possible pain").
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From Baseline at 1 month
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Changes in Pain Pressure Threshold
Time Frame: From Baseline at 2 weeks
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Two Pain Pressure Thresholds will be measured by a handheld algometer, one over the most painful area (peripheric hyperalgesia) and the other one over the middle of the distal phalanx of the thumb (central hyperalgesia).
The Pain Pressure Threshold will be applied with the algometer perpendicular to the skin increasing at a rate of 1 kg/s until the first sensation of pain. 3 measures with 30-seconds rest between them will be performed, taking the average as Pain Pressure Threshold.
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From Baseline at 2 weeks
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Changes in Pain Pressure Threshold
Time Frame: From Baseline at 1 month
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Two Pain Pressure Thresholds will be measured by a handheld algometer, one over the most painful area (peripheric hyperalgesia) and the other one over the middle of the distal phalanx of the thumb (central hyperalgesia).
The Pain Pressure Threshold will be applied with the algometer perpendicular to the skin increasing at a rate of 1 kg/s until the first sensation of pain. 3 measures with 30-seconds rest between them will be performed, taking the average as Pain Pressure Threshold.
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From Baseline at 1 month
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Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Beck Depression Inventory
Time Frame: Baseline
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Measures depressive symptoms.
Scores range from 0 to 63 leading to 6 groups: 0-10, normal; 11-16, mild mood disturbance; 17-20, borderline clinical depression; 21-30, moderate depression; 31-40, severe depression; and over 40, extreme depression.
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Baseline
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Beck Depression Inventory
Time Frame: At 2 weeks from Baseline
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Measures depressive symptoms.
Scores range from 0 to 63 leading to 6 groups: 0-10, normal; 11-16, mild mood disturbance; 17-20, borderline clinical depression; 21-30, moderate depression; 31-40, severe depression; and over 40, extreme depression.
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At 2 weeks from Baseline
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Beck Depression Inventory
Time Frame: At 1 month from Baseline
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Measures depressive symptoms.
Scores range from 0 to 63 leading to 6 groups: 0-10, normal; 11-16, mild mood disturbance; 17-20, borderline clinical depression; 21-30, moderate depression; 31-40, severe depression; and over 40, extreme depression.
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At 1 month from Baseline
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State-Trait Anxiety Inventory
Time Frame: Baseline
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Measures anxious states and anxious traits.
It has 20 items for assessing trait anxiety and 20 for state anxiety.
All items are rated on a 4-point scale (e.g., from "Almost Never" to "Almost Always").
Higher scores indicate greater anxiety.
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Baseline
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State-Trait Anxiety Inventory
Time Frame: At 2 weeks from Baseline
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Measures anxious states and anxious traits.
It has 20 items for assessing trait anxiety and 20 for state anxiety.
All items are rated on a 4-point scale (e.g., from "Almost Never" to "Almost Always").
Higher scores indicate greater anxiety.
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At 2 weeks from Baseline
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State-Trait Anxiety Inventory
Time Frame: At 1 month from Baseline
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Measures anxious states and anxious traits.
It has 20 items for assessing trait anxiety and 20 for state anxiety.
All items are rated on a 4-point scale (e.g., from "Almost Never" to "Almost Always").
Higher scores indicate greater anxiety.
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At 1 month from Baseline
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Tampa Scale of Kinesiophobia
Time Frame: Baseline
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Measures fear of movement-related pain.
Its scores range from 11-44 points with higher scores indicating greater fear of pain, movement, and injury.
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Baseline
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Tampa Scale of Kinesiophobia
Time Frame: At 2 weeks from Baseline
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Measures fear of movement-related pain.
Its scores range from 11-44 points with higher scores indicating greater fear of pain, movement, and injury.
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At 2 weeks from Baseline
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Tampa Scale of Kinesiophobia
Time Frame: At 1 month from Baseline
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Measures fear of movement-related pain.
Its scores range from 11-44 points with higher scores indicating greater fear of pain, movement, and injury.
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At 1 month from Baseline
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Pain Catastrophizing Scale
Time Frame: Baseline
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Measures catastrophizing thinking.
Its total score range from 0-52, along with three subscale scores assessing rumination, magnification and helplessness, with higher scores indicating higher level of catastrophizing.
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Baseline
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Pain Catastrophizing Scale
Time Frame: At 2 weeks from Baseline
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Measures catastrophizing thinking.
Its total score range from 0-52, along with three subscale scores assessing rumination, magnification and helplessness, with higher scores indicating higher level of catastrophizing.
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At 2 weeks from Baseline
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Pain Catastrophizing Scale
Time Frame: At 1 month from Baseline
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Measures catastrophizing thinking.
Its total score range from 0-52, along with three subscale scores assessing rumination, magnification and helplessness, with higher scores indicating higher level of catastrophizing.
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At 1 month from Baseline
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Unified Parkinson´s Disease Rating Scale
Time Frame: Baseline
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Measures disability in Parkinson´s Disease patients.
The scale itself has four components: Part I, Mentation, Behavior and Mood; Part II, Activities of Daily Living; Part III, Motor aspects; Part IV, Associated Complications.
Scores range from 0 to 159 with higher scores indicating more severity.
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Baseline
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Unified Parkinson´s Disease Rating Scale
Time Frame: At 2 weeks from Baseline
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Measures disability in Parkinson´s Disease patients.
The scale itself has four components: Part I, Mentation, Behavior and Mood; Part II, Activities of Daily Living; Part III, Motor aspects; Part IV, Associated Complications.
Scores range from 0 to 159 with higher scores indicating more severity.
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At 2 weeks from Baseline
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Unified Parkinson´s Disease Rating Scale
Time Frame: At 1 month from Baseline
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Measures disability in Parkinson´s Disease patients.
The scale itself has four components: Part I, Mentation, Behavior and Mood; Part II, Activities of Daily Living; Part III, Motor aspects; Part IV, Associated Complications.
Scores range from 0 to 159 with higher scores indicating more severity.
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At 1 month from Baseline
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Reaction Times
Time Frame: Baseline
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Performed through 2 related subtasks.
Finger Taping task, where the participants will be instructed to press the space bar on the keyboard as fast as possible and repeatedly with the index finger, to measure motor function.
And Simple Reaction Time task, where participants will be instructed to press the left mouse button as fast as possible when the stimulus "+" appears in the center of the screen at a size of 2 cm x 2 cm, to measure simple perception and sustained alertness.
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Baseline
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Reaction Times
Time Frame: At 2 weeks from Baseline
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Performed through 2 related subtasks.
Finger Taping task, where the participants will be instructed to press the space bar on the keyboard as fast as possible and repeatedly with the index finger, to measure motor function.
And Simple Reaction Time task, where participants will be instructed to press the left mouse button as fast as possible when the stimulus "+" appears in the center of the screen at a size of 2 cm x 2 cm, to measure simple perception and sustained alertness.
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At 2 weeks from Baseline
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Reaction Times
Time Frame: At 1 month from Baseline
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Performed through 2 related subtasks.
Finger Taping task, where the participants will be instructed to press the space bar on the keyboard as fast as possible and repeatedly with the index finger, to measure motor function.
And Simple Reaction Time task, where participants will be instructed to press the left mouse button as fast as possible when the stimulus "+" appears in the center of the screen at a size of 2 cm x 2 cm, to measure simple perception and sustained alertness.
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At 1 month from Baseline
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Transcranial Magnetic Stimulation
Time Frame: Baseline
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Action Motor Threshold in millivolts
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Baseline
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Transcranial Magnetic Stimulation
Time Frame: At 2 weeks from Baseline
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Action Motor Threshold in millivolts
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At 2 weeks from Baseline
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Transcranial Magnetic Stimulation
Time Frame: At 1 month from Baseline
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Action Motor Threshold in millivolts
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At 1 month from Baseline
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Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Principal Investigator: Josué Fernandez Carnero, PT PhD, Universidad Rey Juan Carlos
Publications and helpful links
General Publications
- 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. A sham-controlled, phase II trial of transcranial direct current stimulation for the treatment of central pain in traumatic spinal cord injury. Pain. 2006 May;122(1-2):197-209. doi: 10.1016/j.pain.2006.02.023. Epub 2006 Mar 27.
- Silverdale MA, Kobylecki C, Kass-Iliyya L, Martinez-Martin P, Lawton M, Cotterill S, Chaudhuri KR, Morris H, Baig F, Williams N, Hubbard L, Hu MT, Grosset DG; UK Parkinson's Pain Study Collaboration. A detailed clinical study of pain in 1957 participants with early/moderate Parkinson's disease. Parkinsonism Relat Disord. 2018 Nov;56:27-32. doi: 10.1016/j.parkreldis.2018.06.001. Epub 2018 Jun 6.
- Chaudhuri KR, Rizos A, Trenkwalder C, Rascol O, Pal S, Martino D, Carroll C, Paviour D, Falup-Pecurariu C, Kessel B, Silverdale M, Todorova A, Sauerbier A, Odin P, Antonini A, Martinez-Martin P; EUROPAR and the IPMDS Non Motor PD Study Group. King's Parkinson's disease pain scale, the first scale for pain in PD: An international validation. Mov Disord. 2015 Oct;30(12):1623-31. doi: 10.1002/mds.26270. Epub 2015 Jun 11.
- Fregni F, Boggio PS, Santos MC, Lima M, Vieira AL, Rigonatti SP, Silva MT, Barbosa ER, Nitsche MA, Pascual-Leone A. Noninvasive cortical stimulation with transcranial direct current stimulation in Parkinson's disease. Mov Disord. 2006 Oct;21(10):1693-702. doi: 10.1002/mds.21012.
- Lefaucheur JP, Antal A, Ayache SS, Benninger DH, Brunelin J, Cogiamanian F, Cotelli M, De Ridder D, Ferrucci R, Langguth B, Marangolo P, Mylius V, Nitsche MA, Padberg F, Palm U, Poulet E, Priori A, Rossi S, Schecklmann M, Vanneste S, Ziemann U, Garcia-Larrea L, Paulus W. Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS). Clin Neurophysiol. 2017 Jan;128(1):56-92. doi: 10.1016/j.clinph.2016.10.087. Epub 2016 Oct 29.
- Kalia LV, Lang AE. Parkinson's disease. Lancet. 2015 Aug 29;386(9996):896-912. doi: 10.1016/S0140-6736(14)61393-3. Epub 2015 Apr 19.
- Antonini A, Tinazzi M, Abbruzzese G, Berardelli A, Chaudhuri KR, Defazio G, Ferreira J, Martinez-Martin P, Trenkwalder C, Rascol O. Pain in Parkinson's disease: facts and uncertainties. Eur J Neurol. 2018 Jul;25(7):917-e69. doi: 10.1111/ene.13624. Epub 2018 Apr 18.
- Perez-Lloret S, Ciampi de Andrade D, Lyons KE, Rodriguez-Blazquez C, Chaudhuri KR, Deuschl G, Cruccu G, Sampaio C, Goetz CG, Schrag A, Martinez-Martin P, Stebbins G; Members of the MDS Committee on Rating Scales Development. Rating Scales for Pain in Parkinson's Disease: Critique and Recommendations. Mov Disord Clin Pract. 2016 Jun 24;3(6):527-537. doi: 10.1002/mdc3.12384. eCollection 2016 Nov-Dec.
- Imai Y, Petersen KK, Morch CD, Arendt Nielsen L. Comparing test-retest reliability and magnitude of conditioned pain modulation using different combinations of test and conditioning stimuli. Somatosens Mot Res. 2016 Sep-Dec;33(3-4):169-177. doi: 10.1080/08990220.2016.1229178. Epub 2016 Sep 20.
- Santos-Garcia D, Oreiro M, Perez P, Fanjul G, Paz Gonzalez JM, Feal Painceiras MJ, Cores Bartolome C, Valdes Aymerich L, Garcia Sancho C, Castellanos Rodrigo MDM. Impact of Coronavirus Disease 2019 Pandemic on Parkinson's Disease: A Cross-Sectional Survey of 568 Spanish Patients. Mov Disord. 2020 Oct;35(10):1712-1716. doi: 10.1002/mds.28261. Epub 2020 Sep 22.
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Estimate)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- PainPD-tDCS
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- Study Protocol
- Statistical Analysis Plan (SAP)
- Informed Consent Form (ICF)
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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