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The aims of this study are threefold. First, to investigate whether spinal nociceptive processing - represented here by the nociceptive flexion reflex (NFR) - is influenced by thoracic transcutaneous spinal direct current stimulation (tsDCS) in a spatially selective manner, i.e., whether effects are only observed for lower limb NFRs, but not for upper limb NFRs. Second, to investigate - in a double-blind, sham-controlled, within-participant design - whether anodal and cathodal tsDCS do affect the NFR in a polarity-dependent manner. Third, to investigate whether tsDCS effects observed on a spinal measure (NFR) are also observed in responses that are mediated supra-spinally, namely autonomic parameters and pain intensity ratings.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Anodal thoracic tsDCS | Experimental | Anodal tsDCS will be applied over the T12 vertebra |
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| Cathodal thoracic tsDCS | Experimental | Cathodal tsDCS will be applied over the T12 vertebra |
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| Sham thoracic tsDCS | Sham Comparator | Sham tsDCS will be applied over the T12 vertebra |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Transcutaneous spinal direct current stimulation (tsDCS) | Other | tsDCS will be carried out using a direct current stimulator (DC-Stimulator Plus, neuroConn, Ilmenau, Germany), with one electrode placed above the thoracic spinal cord and the other electrode placed on the right shoulder. We will employ rectangular electrodes of 7 x 5 cm size (neuroConn, Ilmenau, Germany) covered by electrode paste (Ten20 Conductive Paste, Weaver and Company, Aurora, USA). Stimulation will consist of the following phases: a fade-in period of 15 seconds, a plateau period of 20 minutes (with stimulation at 2.5mA either anodally or cathodally) and a fade-out period of 15 seconds. Sham stimulation will follow the anodal montage with 15-second fade-in and fade-out periods, but only 45 seconds of plateau stimulation at 2.5 mA. Such a combination of stimulation and electrodes results in a current density of 0.071mA/cm2, well below thermal and histological limits for current density. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in NFR amplitude | 90-150ms for lower limb, 60-200ms for upper limb | Baseline and immediately after the intervention |
| Change in pain intensity rating | One rating per trial on a standard visual analogue scale (VAS); internally numbered from 0 (no sensation) to 100 (unbearable pain) | Baseline and immediately after the intervention |
| Change in skin conductance response | Amplitude maximum before onset of pain rating | Baseline and immediately after the intervention |
| Change in heart period acceleration | Amplitude maximum before onset of pain rating | Baseline and immediately after the intervention |
| Measure | Description | Time Frame |
|---|---|---|
| Change in NFR area | 90-150ms for lower limb, 60-200ms for upper limb | Baseline and immediately after the intervention |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Max Planck Research Group Pain Perception | Leipzig | Germany |
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| ID | Term |
|---|---|
| D010146 | Pain |
| ID | Term |
|---|---|
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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