{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T23:31:04Z","timestamp":1779147064177,"version":"3.51.4"},"reference-count":42,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T00:00:00Z","timestamp":1722470400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Introduction<\/jats:title><jats:p>Similar to chronic pain conditions, individuals with endometriosis can be affected by central sensitization syndrome (CSS), which is characterized by a loss of analgesia and central amplification of pain. Transcranial direct current stimulation (tDCS) has shown potential as an effective intervention to improve pain generated by other chronic pain conditions impacted by CSS, such as fibromyalgia and chronic pelvic issues. This study aims to evaluate the effectiveness of tDCS on pain, fatigue, and quality of life among patients affected by endometriosis.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>This is a single-center, parallel, double-blinded, randomized, controlled clinical trial protocol study. We aim to recruit 40 participants affected by endometriosis (active group, n = 20; sham group, n = 20). Anodal tDCS will be delivered at an intensity of 2mA, applied over the primary motor cortex for 20 minutes per day for 10 consecutive days. There will be four assessment times: 1 week before beginning the intervention; on the 10<jats:sup>th<\/jats:sup>day following the last tDCS session; and 1 and 2 months after the last tDCS session. Pain evaluated by the algometry will be the primary outcome. Pain intensity, quality of life, fatigue, and global perception of change will be the secondary outcomes. We will calculate the effects of the active versus sham stimulation on primary and secondary outcomes by using generalized estimated equations or mixed model analysis. The effect size calculation will represent the effect measure. We expect that only the active group show reductions in pain, fatigue, and quality of life. The results of this trial will produce an important first step in providing evidence on the effectiveness of neuromodulation for the management of pain and will provide data to support new studies on tDCS.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Registration<\/jats:title><jats:p>Brazilian Clinical Trials Registry (RBR-4q69573).<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0306405","type":"journal-article","created":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T17:42:00Z","timestamp":1722534120000},"page":"e0306405","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Investigating the efficacy of transcranial direct current stimulation on chronic pain management in endometriosis patients: A randomized controlled trial protocol"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7812-2492","authenticated-orcid":true,"given":"Tatiana","family":"Camila de Lima Alves da Silva","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H\u00e9gila","family":"da Silva Dantas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luiza","family":"Eduarda Macedo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4504-6160","authenticated-orcid":true,"given":"Talita","family":"Duarte Martins","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0732-5049","authenticated-orcid":true,"given":"Edson","family":"Silva-Filho","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rodrigo","family":"Pegado","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda","family":"McLean","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Thereza Albuquerque Barbosa Cabral Micussi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,8,1]]},"reference":[{"issue":"8","key":"pone.0306405.ref001","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1007\/s10815-010-9436-1","article-title":"Endometriosis and infertility.","volume":"27","author":"C Bulletti","year":"2010","journal-title":"J Assist Reprod Genet"},{"issue":"10276","key":"pone.0306405.ref002","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1016\/S0140-6736(21)00389-5","article-title":"Endometriosis is a chronic systemic disease: clinical challenges and novel innovations","volume":"397","author":"HS Taylor","year":"2021","journal-title":"Lancet"},{"issue":"3","key":"pone.0306405.ref003","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1016\/j.fertnstert.2012.06.029","article-title":"Pathogenesis and pathophysiology of endometriosis","volume":"98","author":"RO Burney","year":"2012","journal-title":"Fertil Steril"},{"issue":"13","key":"pone.0306405.ref004","doi-asserted-by":"crossref","first-page":"4683","DOI":"10.3390\/ijerph17134683","article-title":"The burden of endometriosis on women\u2019s lifespan: a narrative overview on quality of life and psychosocial wellbeing","volume":"17","author":"LD Della Corte","year":"2020","journal-title":"Int J Environ Res Public Health"},{"issue":"2","key":"pone.0306405.ref005","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/S1474-4422(07)70032-7","article-title":"Recent advances in the treatment of chronic pain with non-invasive brain stimulation techniques","volume":"6","author":"F Fregni","year":"2007","journal-title":"Lancet Neurol"},{"issue":"5","key":"pone.0306405.ref006","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1097\/AOG.0b013e3182a7e1f5","article-title":"Increased pressure pain sensitivity in women with chronic pelvic pain","volume":"122","author":"S As-Sanie","year":"2013","journal-title":"Obstet Gynecol"},{"issue":"5944","key":"pone.0306405.ref007","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1038\/306686a0","article-title":"Evidence for a central component of post-injury pain hypersensitivity","volume":"306","author":"CJ Woolf","year":"1983","journal-title":"Nature"},{"issue":"6","key":"pone.0306405.ref008","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.semarthrit.2007.09.003","article-title":"Central sensitivity syndromes: a new paradigm and group nosology for fibromyalgia and overlapping conditions, and the related issue of disease versus illness","volume":"37","author":"MB Yunus","year":"2008","journal-title":"Sem Arthritis Rheum"},{"key":"pone.0306405.ref009","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.12688\/f1000research.15956.2","article-title":"Central sensitization and pain hypersensitivity: some critical considerations.","volume":"7","author":"EM Van den Broeke","year":"2018","journal-title":"F1000Res"},{"issue":"5","key":"pone.0306405.ref010","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1097\/AJP.0b013e31823853e3","article-title":"Transcranial direct current stimulation for the reduction of clinical and experimentally induced pain: a systematic review and meta-analysis","volume":"28","author":"K Luedtke","year":"2012","journal-title":"Clin J Pain"},{"issue":"1","key":"pone.0306405.ref011","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.clinph.2016.10.087","article-title":"Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS).","volume":"128","author":"JP Lefaucheur","year":"2017","journal-title":"Clin Neurophysiol"},{"issue":"2","key":"pone.0306405.ref012","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.brs.2008.09.009","article-title":"A preliminary study of transcranial direct current stimulation for the treatment of refractory chronic pelvic pain","volume":"2","author":"BW Fenton","year":"2009","journal-title":"Brain Stimul"},{"key":"pone.0306405.ref013","first-page":"243","article-title":"Modulating anxiety and functional capacity with anodal tDCS over the left dorsolateral prefrontal cortex in primary dysmenorrhea.","volume":"12","author":"LRDV Dutra","year":"2020","journal-title":"Int J Women\u2019s Health"},{"issue":"12","key":"pone.0306405.ref014","doi-asserted-by":"crossref","first-page":"3615","DOI":"10.1093\/pm\/pnz202","article-title":"Effects of transcranial direct current stimulation for treatment of primary dysmenorrhea: preliminary results of a randomized sham-controlled trial","volume":"21","author":"R Pegado","year":"2019","journal-title":"Pain Med"},{"issue":"6","key":"pone.0306405.ref015","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.neucli.2016.10.002","article-title":"A comprehensive database of published tDCS clinical trials (2005\u20132016).","volume":"46","author":"JP Lefaucheur","year":"2016","journal-title":"Neurophysiol Clin"},{"issue":"6","key":"pone.0306405.ref016","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1002\/nau.25205","article-title":"Noninvasive brain stimulation in the treatment of functional urological and pelvic floor disorders: A scoping review","volume":"42","author":"C Mazeaud","year":"2023","journal-title":"Neurourol Urodyn"},{"issue":"3","key":"pone.0306405.ref017","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.brs.2011.03.002","article-title":"Clinical research with transcranial direct current stimulation (tDCS): challenges and future directions.","volume":"5","author":"AR Brunoni","year":"2012","journal-title":"Brain Stimul"},{"issue":"7","key":"pone.0306405.ref018","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1093\/pm\/pnad031","article-title":"Transcranial direct current stimulation to reduce chronic pelvic pain in endometriosis: phase II randomized controlled clinical trial","volume":"24","author":"S Mechsner","year":"2023","journal-title":"Pain Med"},{"issue":"10276","key":"pone.0306405.ref019","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1016\/S0140-6736(21)00389-5","article-title":"Endometriosis is a chronic systemic disease: clinical challenges and novel innovations","volume":"397","author":"HS Taylor","year":"2021","journal-title":"Lancet"},{"issue":"4","key":"pone.0306405.ref020","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1210\/jc.2011-3362","article-title":"Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging","volume":"97","author":"SD Harlow","year":"2012","journal-title":"J Clin Endocrinol Metab"},{"issue":"1","key":"pone.0306405.ref021","doi-asserted-by":"crossref","first-page":"e692","DOI":"10.1097\/PR9.0000000000000692","article-title":"Latin American and Caribbean consensus on noninvasive central nervous system neuromodulation for chronic pain management (LAC 2-NIN-CP).","volume":"4","author":"AF Baptista","year":"2019","journal-title":"Pain Rep."},{"issue":"2","key":"pone.0306405.ref022","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1016\/j.clinph.2015.11.012","article-title":"A technical guide to tDCS, and related non-invasive brain stimulation tools","volume":"127","author":"AJ Woods","year":"2016","journal-title":"Clin Neurophysiol"},{"issue":"4","key":"pone.0306405.ref023","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1016\/j.clinph.2005.12.003","article-title":"Transcranial DC stimulation (tDCS): A tool for double-blind sham-controlled clinical studies in brain stimulation.","volume":"117","author":"PC Gandiga","year":"2006","journal-title":"Clin Neurophysiol"},{"key":"pone.0306405.ref024","doi-asserted-by":"crossref","first-page":"e10162","DOI":"10.7717\/peerj.10162","article-title":"Instrumental validity and intra\/inter-rater reliability of a novel low-cost digital pressure algometer.","volume":"8","author":"D Jerez-Mayorga","year":"2020","journal-title":"PeerJ"},{"issue":"2","key":"pone.0306405.ref025","doi-asserted-by":"crossref","first-page":"227","DOI":"10.34024\/rnc.2014.v22.8094","article-title":"Mapping the body distribution of pain perception in fibromyalgia","volume":"22","author":"A Freitas RP de","year":"2014","journal-title":"Rev Neurociencias"},{"issue":"1","key":"pone.0306405.ref026","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1590\/1809-2950\/17243825012018","article-title":"Controle postural de mulheres com dismenorreia prim\u00e1ria em dois momentos do ciclo menstrual.","volume":"25","author":"JH Stallbaum","year":"2018","journal-title":"Fisioter Pesqui."},{"key":"pone.0306405.ref027","doi-asserted-by":"crossref","first-page":"100037","DOI":"10.1016\/j.eurox.2019.100037","article-title":"Correlations among algometry, the visual analogue scale, and the numeric rating scale to assess chronic pelvic pain in women","volume":"3","author":"MM Alfonsin","year":"2019","journal-title":"Eur J Obstet Gynecol Reprod Biol X"},{"key":"pone.0306405.ref028","doi-asserted-by":"crossref","first-page":"S240","DOI":"10.1002\/acr.20543","article-title":"Measures of adult pain: visual analog scale for pain (VAS pain), numeric rating scale for pain (NRS pain), mcgill pain questionnaire (MPQ), short-form mcgill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP).","volume":"63","author":"GA Hawker","year":"2011","journal-title":"Arthritis Care Res (Hoboken)."},{"issue":"1","key":"pone.0306405.ref029","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.fertnstert.2008.09.056","article-title":"Pain scoring in endometriosis: entry criteria and outcome measures for clinical trials. report from the art and science of endometriosis meeting","volume":"93","author":"K Vincent","year":"2010","journal-title":"Fertil Steril"},{"issue":"3","key":"pone.0306405.ref030","doi-asserted-by":"crossref","first-page":"7603205040","DOI":"10.5014\/ajot.2022.044420","article-title":"Assessment of Low Back Pain: Reliability and Minimal Detectable Change of the Brief Pain Inventory.","volume":"76","author":"CY Song","year":"2022","journal-title":"Am J Occup Ther"},{"issue":"1","key":"pone.0306405.ref031","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.jphys.2015.07.001","article-title":"The Brief Pain Inventory (BPI).","volume":"62","author":"N Poquet","year":"2016","journal-title":"J Physiother."},{"issue":"2","key":"pone.0306405.ref032","first-page":"129","article-title":"Pain assessment: global use of the brief pain inventory","volume":"23","author":"CS Cleeland","year":"1994","journal-title":"Ann Acad Med Singap"},{"issue":"1","key":"pone.0306405.ref033","doi-asserted-by":"crossref","first-page":"hoab042","DOI":"10.1093\/hropen\/hoab042","article-title":"Health-related quality of life in women with endometriosis: psychometric validation of the Endometriosis Health Profile 30 questionnaire using confirmatory factor analysis","volume":"2022","author":"KE Hansen","year":"2021","journal-title":"Hum Reprod Open"},{"issue":"8","key":"pone.0306405.ref034","first-page":"384","article-title":"Valida\u00e7\u00e3o de vers\u00e3o para o portugu\u00eas de question\u00e1rio sobre qualidade de vida para mulher com endometriose (Endometriosis Health Profile Questionnaire\u2014EHP-30).","volume":"30","author":"CV Mengarda","year":"2008","journal-title":"Rev Bras Ginecol Obs"},{"issue":"1","key":"pone.0306405.ref035","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1186\/s41687-022-00508-0","article-title":"Functional Assessment of Chronic Illness Therapy-Fatigue is a reliable and valid measure in patients with active ankylosing spondylitis.","volume":"6","author":"D Cella","year":"2022","journal-title":"J Patient Rep Outcomes."},{"key":"pone.0306405.ref036","first-page":"S263","article-title":"Measures of fatigue: bristol rheumatoid arthritis fatigue multi-dimensional questionnaire (BRAF MDQ), bristol rheumatoid arthritis fatigue numerical rating scales (BRAF NRS) for severity, effect, and coping, chalder fatigue questionnaire (CFQ), checklist.","volume":"63","author":"S Hewlett","year":"2011","journal-title":"Arthritis Care Res (Hoboken)."},{"issue":"6","key":"pone.0306405.ref037","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1016\/j.jpain.2015.02.007","article-title":"Patients\u2019 impression of change following treatment for chronic pain: global, specific, a single dimension, or many?","volume":"16","author":"W Scott","year":"2015","journal-title":"J Pain."},{"issue":"1","key":"pone.0306405.ref038","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.pmn.2022.07.005","article-title":"Neuropathic pain symptom inventory (NPSI) questionnaire-persian version can differentiate neuropathic from non-neuropathic pain.","volume":"24","author":"SP Madani","year":"2023","journal-title":"Pain Manag Nurs."},{"issue":"5","key":"pone.0306405.ref039","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1055\/s-2005-836904","article-title":"ENZIAN-score, a classification of deep infiltrating endometriosis.","volume":"127","author":"F Tuttlies","year":"2005","journal-title":"Zentralbl Gynakol"},{"issue":"3","key":"pone.0306405.ref040","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1016\/j.jbmt.2017.12.014","article-title":"Effect of one session of tDCS on the severity of pain in women with chronic pelvic pain","volume":"23","author":"N Divandari","year":"2019","journal-title":"J Bodyw Mov Ther"},{"issue":"1","key":"pone.0306405.ref041","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1076\/anec.11.1.1.29366","article-title":"Validation of a modified version of the mini-mental state examination (MMSE) in spanish.","volume":"11","author":"SR Beaman","year":"2004","journal-title":"Aging, Neuropsychology, and Cognition."},{"issue":"10","key":"pone.0306405.ref042","doi-asserted-by":"crossref","first-page":"1706","DOI":"10.1002\/sim.6817","article-title":"Covariance estimators for generalized estimating equations (GEE) in longitudinal analysis with small samples.","volume":"35","author":"M Wang","year":"2016","journal-title":"Stat Med"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0306405","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,25]],"date-time":"2024-11-25T15:36:35Z","timestamp":1732548995000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0306405"}},"subtitle":[],"editor":[{"given":"Thiago P.","family":"Fernandes","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2024,8,1]]},"references-count":42,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,8,1]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0306405","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,1]]}}}