Our programs are based on a form of neuromodulation, known as transcranial direct current stimulation (tDCS). Nuraleve has developed a platform technology and service applying tDCS to reduce pain symptoms associated with many chronic pain indications, with studies showing effectiveness for such indications as fibromyalgia, chronic headaches (including migraines), and painful diabetic neuropathy. It has also been shown effective in reducing cravings.
This technique involves the delivery of a weak electrical current to the brain via surface (i.e., scalp) electrodes, and affects brain activity by modulating the threshold of the neuronal resting membrane potential. The resting state potential can be hyperpolarized by cathodal stimulation (causing a decrease in cortical excitability) or depolarized by anodal stimulation (resulting in an increase in cortical excitability).
Mechanism of action
Chronic pain has been shown to result in long‐lasting brain changes, both structural and functional, at both cortical and subcortical levels, including somatotopic reorganization, sustained increases in neuronal excitability, and decreased cortical thickness in associated brain regions. These changes are believed to be due to maladaptive neuroplasticity, which results in the persistence of pain past the point of tissue healing and the development and preservation of chronic pain. The effectiveness of tDCS for various types of chronic pain is believed to be due in part to the facilitation of beneficial neuroplastic changes (along with the reversal of maladaptive ones), resulting in both acute and long-term reductions in pain.
A promising feature of tDCS is its ability to induce neuroplasticity, engaging some of the same systems (e.g., dopamine, glutamate) that figure prominently in the pathological neuroplasticity caused by addictive drugs such as nicotine. Drug-induced neuroplasticity is thought to underlie the cravings for cigarettes, and by extension, the long-lasting vulnerability to relapse that characterizes addiction. By enhancing neuroplasticity, tDCS offers the potential to reverse some of the motivational consequences of cravings and reduce the risk of relapse.
Efficacy
Double‐blind, randomized trials conducted to date support the notion that cortical stimulation via tDCS significantly reduces pain associated with many chronic indications, including in patients suffering from fibromyalgia, chronic headaches, and various forms of neuropathic pain. In many of these studies, these effects persisted past the conclusion of stimulation, with studies showing pain improvements lasting up to four months post‐stimulation. Furthermore, stimulation has shown to improve not only the intensity of experienced pain, but the duration of pain symptoms, as well.
There are also multiple double-blind clinical trials that support the notion that anodal tDCS stimulation significantly reduces several types of cravings, including those for cigarettes, food, and marijuana. It has also been shown to improve related aspects of cognitive functioning such as decision making and inhibitory control. Given that a similar addiction pathway, which includes the left dorsolateral prefrontal cortex (DLPFC) region, is responsible for cravings for nicotine, alcohol and food, as well as for the cognitive deficits seen in drug addicted individuals, it is not surprising that tDCS stimulation to the left DLPFC results in these beneficial effects.
Our literature review for chronic pain management is available for download here and for cravings reduction here.