{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T04:09:26Z","timestamp":1769832566659,"version":"3.49.0"},"reference-count":73,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T00:00:00Z","timestamp":1677628800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Some patients with neuralgia of cranial nerves with otherwise therapy-refractory pain respond to invasive therapy with local anesthetics. Unfortunately, pain regularly relapses despite multimodal pain management. Transcranial direct current stimulation (tDCS) may prolong pain response due to neuro-modulatory effects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This controlled clinical pilot trial randomized patients to receive anodal, cathodal or sham-tDCS stimulation prior to local anesthetic infiltration. Pain attenuation, quality-of-life and side effects were assessed and compared with historic controls to estimate effects of tDCS stimulation setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Altogether, 17 patients were randomized into three groups with different stimulation protocols. Relative reduction of pain intensity in per protocol treated patients were median 73%, 50% and 69% in anodal, cathodal and sham group, respectively (<jats:italic>p<\/jats:italic> = 0.726). Compared with a historic control group, a lower rate of responders with 50% reduction of pain intensity indicates probable placebo effects (OR 3.41 stimulation vs. non-stimulation setting, NNT 3.63). 76.9% (<jats:italic>n<\/jats:italic> = 10) of tDCS patients reported mild side-effects. Of all initially included 17 patients, 23.5% (<jats:italic>n<\/jats:italic> = 4) withdrew their study participation with highest proportion in the cathodal group (<jats:italic>n<\/jats:italic> = 3). A sample size calculation for a confirmatory trial revealed 120 patients using conservative estimations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>This pilot trial does not support series of anodal tDCS as neuro-modulatory treatment to enhance pain alleviation of local anesthetic infiltration series. Notably, results may indicate placebo effects of tDCS settings. Feasibility of studies in this population was limited due to relevant drop-out rates. Anodal tDCS warrants further confirmation as neuro-modulatory pain treatment option.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2023.1069434","type":"journal-article","created":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T07:30:32Z","timestamp":1677655832000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Supplementing transcranial direct current stimulation to local infiltration series for refractory neuropathic craniocephalic pain: A randomized controlled pilot trial"],"prefix":"10.3389","volume":"14","author":[{"given":"Jan D.","family":"Wandrey","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joanna","family":"Kastelik","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Fritzsche","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Denke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Sch\u00e4fer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sascha","family":"Tafelski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,3,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1007\/s11916-017-0609-9","article-title":"Atypical facial pain: a comprehensive, evidence-based review","author":"Weiss","year":"2017","journal-title":"Curr Pain Headache Rep."},{"key":"B2","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1097\/j.pain.0000000000000454","article-title":"Pain and the global burden of disease","volume":"157","author":"Rice","year":"2016","journal-title":"PAIN."},{"key":"B3","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1097\/j.pain.0000000000001365","article-title":"The IASP classification of chronic pain for ICD-11: chronic neuropathic pain","volume":"160","author":"Scholz","year":"2019","journal-title":"Pain."},{"key":"B4","doi-asserted-by":"publisher","first-page":"17002","DOI":"10.1038\/nrdp.2017.2","article-title":"Neuropathic pain","volume":"3","author":"Colloca","year":"2017","journal-title":"Nat Rev Dis Prim."},{"key":"B5","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1016\/S1474-4422(14)70251-0","article-title":"Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis","volume":"14","author":"Finnerup","year":"2015","journal-title":"Lancet Neurol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"8685954","DOI":"10.1155\/2019\/8685954","article-title":"Therapeutic Approaches for Peripheral and Central Neuropathic Pain.","volume":"2019","author":"Szok","year":"2019","journal-title":"Behav Neurol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"2249","DOI":"10.1016\/j.pain.2013.06.004","article-title":"Interventional management of neuropathic pain: NeuPSIG recommendations","volume":"154","author":"Dworkin","year":"2013","journal-title":"Pain."},{"key":"B8","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1007\/s11916-012-0308-5","article-title":"Interventional Procedures for Facial Pain","volume":"17","author":"Vorenkamp","year":"2012","journal-title":"Curr Pain Headache Rep."},{"key":"B9","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1007\/s00482-014-1503-6","article-title":"Praxis der regionalan\u00e4sthesiologischen Behandlung chronischer Schmerzpatienten in der station\u00e4ren und ambulanten Versorgung","volume":"29","author":"Tafelski","year":"2015","journal-title":"Der Schmerz."},{"key":"B10","doi-asserted-by":"publisher","first-page":"6042941","DOI":"10.1155\/2020\/6042941","article-title":"Retrospective study on ganglionic and nerve block series as therapeutic option for chronic pain patients with refractory neuropathic pain. 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