Additional Effects of Transcranial Direct-Current Stimulation and Trigger-Point Injection for Treatment of Myofascial Pain Syndrome: A Pilot Study with Randomized, Single-Blinded Trial

Abstract

Background: Chronic pain caused by myofascial pain syndrome (MPS) results in generalized and debilitating conditions. Trigger-point injection (TPI) is the mainstay of MPS management to reduce acute and localized pain. Other adjunctive intervention to modulate the central pain pathway might be helpful if they are combined with TPI. Transcranial direct-current stimulation (tDCS), which is a form of neurostimulation, has been reported to be safe and effective in treating chronic pain by changing cortical excitability. Objectives: To determine whether there is an additional effect of tDCS and TPI to reduce pain in patients with MPS. Patients: Twenty-one patients with newly diagnosed MPS of shoulder girdle muscles. Interventions: Patients were randomly assigned into 1 of 3 groups (2 active and 1 sham stimulation groups) and received TPI. Immediately after TPI, tDCS (2 mA for 20 minutes on 5 consecutive days) was administered. For the active stimulation groups, tDCS was applied over 2 different locations (primary motor cortex and dorsolateral prefrontal cortex [DLPFC]). Outcome measures: Visual analogue scale (VAS), Pain Threshold Test, and short form of the McGill Pain Questionnaire were measured before and immediately after stimulation for 5 consecutive days. Results: The mean VAS values were decreased in all three groups after 5 days. There was a significant change between before and after stimulation only in the DLPFC group. The significant change in the mean VAS value was shown from after the second stimulation session (p = 0.031), and this remained significant until the last stimulation session (p = 0.027). Conclusion: This study suggests that tDCS over DLPFC may have additional effects with TPI to reduce pain in patients with MPS. tDCS over DLPFC can be used to reverse central pain pathway by modulating cortical plasticity.