{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T07:10:11Z","timestamp":1773645011801,"version":"3.50.1"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T00:00:00Z","timestamp":1773619200000},"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. Pain Res."],"abstract":"\n Background<\/jats:title>\n Autonomous home-based transcranial direct current stimulation (HB-tDCS) is a scalable non-pharmacological intervention for chronic pain, but evidence under fully autonomous use remains limited.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To identify factors associated with adherence to fully autonomous HB-tDCS; to characterize the incidence, severity, and timing of adverse events under active and sham stimulation; and to examine if patient and clinical factors, including adverse events and clinical response, are associated with variability in adherence and safety outcomes.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Secondary pooled analysis of three double blind, sham-controlled randomized clinical trials.<\/jats:p>\n <\/jats:sec>\n \n Subjects<\/jats:title>\n A total of 234 women with fibromyalgia diagnosed according to the 2016 American College of Rheumatology criteria.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Participants received a standardized autonomous HB-tDCS protocol (\u226520 sessions). The primary outcomes were adherence and safety. We examined associations with adherence and adverse events using generalized linear mixed-effects models, adjusted for demographic, clinical, and psychosocial factors. We also explored whether the burden of adverse events explained the link between treatment allocation and adherence.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Overall adherence was 82.6% (95% CI, 81.6\u201383.6). Adherence rates were similar for the active (84.7%, 95% CI, 83.3\u201386.0) and sham groups (80.5%, 95% CI, 78.9\u201382.1). Older age (\n \u03b2<\/jats:italic>\n \u2009=\u2009\u22120.024 sessions\/year; 95% CI, \u22120.040 to \u22120.008) and greater central sensitization (\n \u03b2<\/jats:italic>\n \u2009=\u2009\u22120.025 per point; 95% CI, \u22120.040 to \u22120.010) were associated with lower adherence. Higher depressive symptom severity was linked to higher adherence (\n \u03b2<\/jats:italic>\n \u2009=\u20090.041 per point; 95% CI, 0.040\u20130.060). Most participants reported no adverse events (67.0%, 95% CI, 61.0\u201373.0), with no group differences (\n \u03c7<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u20090.04,\n p<\/jats:italic>\n \u2009=\u20090.83). Reported events were mostly mild and brief. Active stimulation led to more frequent tingling and erythema. Higher education (\n \u03b2<\/jats:italic>\n \u2009=\u20090.078; 95% CI, 0.023\u20130.130) and depressive symptoms (\n \u03b2<\/jats:italic>\n \u2009=\u20090.037; 95% CI, 0.020\u20130.050) were associated with more adverse event reports. Greater functional impairment was linked to fewer reported events (\n \u03b2<\/jats:italic>\n \u2009=\u2009\u22120.003; 95% CI, \u22120.040 to \u22120.007).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Autonomous home-based transcranial direct current stimulation was feasible, safe, and highly adhered to in fibromyalgia, with adherence and safety influenced by clinical and psychosocial factors, supporting scalable implementation in chronic pain.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpain.2026.1773425","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T06:37:40Z","timestamp":1773643060000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Determinants of adherence and safety in fully autonomous home-based transcranial direct current stimulation for fibromyalgia"],"prefix":"10.3389","volume":"7","author":[{"given":"Wolnei","family":"Caumo","sequence":"first","affiliation":[{"name":"Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS)","place":["Porto Alegre, Brazil"]},{"name":"Laboratory of Pain and Neuromodulation, Hospital de Cl\u00ednicas de Porto Alegre (HCPA)","place":["Porto Alegre, Brazil"]},{"name":"Pain and Palliative Care Service, Hospital de Cl\u00ednicas de Porto Alegre (HCPA) and Department of Surgery, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS)","place":["Porto Alegre, Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucas Bohrer","family":"Flores","sequence":"additional","affiliation":[{"name":"Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS)","place":["Porto Alegre, Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabela Souza","family":"Fontoura","sequence":"additional","affiliation":[{"name":"Laboratory of Pain and Neuromodulation, Hospital de Cl\u00ednicas de Porto Alegre (HCPA)","place":["Porto Alegre, Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Graziele Borges","family":"Bueno","sequence":"additional","affiliation":[{"name":"Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS)","place":["Porto Alegre, Brazil"]},{"name":"Laboratory of Pain and Neuromodulation, Hospital de Cl\u00ednicas de Porto Alegre (HCPA)","place":["Porto Alegre, Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paulo Robeto","family":"Stefani Sanches","sequence":"additional","affiliation":[{"name":"Laboratory of Biomedical Engineering, Hospital de Cl\u00ednicas de Porto Alegre (HCPA)","place":["Porto Alegre, Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr","given":"Danton","family":"Pereira Silva","sequence":"additional","affiliation":[{"name":"Laboratory of Biomedical Engineering, Hospital de Cl\u00ednicas de Porto Alegre (HCPA)","place":["Porto Alegre, Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iraci L. 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