TDCS* and Laterality Trainnning in Patients With Chronic Neck Pain

NCT ID: NCT06204627

Last Updated: 2024-05-16

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-09-30

Study Completion Date

2024-12-01

Brief Summary

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Chronic neck pain leads to decreased quality of life and absenteeism at work, generating great personal and socio-economic impact. It has been shown that patients with chronic pain have late recognition of the laterality of the hand, which is related to the duration of symptoms and pain evoked by the execution of the movement. These findings suggest that chronic pain and the consequent disuse of certain motor functions may involve a reorganization of the cortical representation of the body scheme or motor planning.

Non-invasive neuromodulation, such as transcranial direct current stimulation (TDCS), allows modulating cortical excitability and promoting pain relief.

This study intends to verify the effects of the association of noninvasive brain stimulation with TDCS with an intervention with visual and motor stimuli related to laterality in patients with neck pain.

Detailed Description

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The study will be controlled, randomized, double-blind and will include patients with chronic neck pain, divided into four groups:

1. active TDCS associated with laterality recognition stimuli (n = 25);
2. active TDCS associated with landscape recognition stimuli (n = 25);
3. TDCS sham associated with laterality recognition stimuli (n = 25);
4. TDCS sham associated with landscape recognition stimuli (n = 25);

Eight induction sessions will be held twice a week for four weeks. Patients who present a positive response in the first reassessment (responders) will remain in the study follow-up and will undergo a weekly maintenance session, for four weeks, and two more biweekly sessions.

The following instruments will be used for evaluation: motor safety thresholds through a MagVenture pulse generator with a flat surface coil, figure 8; OPAL, device with sensors; Recognize™ application; Visual Analog Scale (VAS); Brief Pain Inventory (BDI); Clinical Global Impression - ICG (patient and evaluated version); Pain McGill Standard Questionnaire - Short Format; Hospital Anxiety and Depression Scale (HAD); 36-item summary health survey from the Medical Outcomes Study (SF-36); Mini best test; neurodynamic tests (upper limb tension tests); and quantitative sensory tests. In addition to the pre- and post-intervention assessments, there will be post-treatment follow-up performed three, six and 12 months after randomization by telephone or e-mail. It is expected that the combined application of tDCS with stimuli related to laterality will have positive effects in patients with neck pain, impacting on variables such as pain, functional movements and quality of life of these patients.

Conditions

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Neck Pain Chronic Pain

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

The study will be controlled, randomized, double-blind and will include patients with chronic neck pain, divided into four groups:

1. active TDCS associated with laterality recognition stimuli (n = 25);
2. active TDCS associated with landscape recognition stimuli (n = 25);
3. TDCS sham associated with laterality recognition stimuli (n = 25);
4. TDCS sham associated with landscape recognition stimuli (n = 25).
Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors
The study will be controlled, randomized and double-blind.

Study Groups

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Active bipolar TDCS associated with laterality recognition stimuli

Participants will have carbon electrodes positioned, with contact through a 5x7cm sponge moistened in saline solution, with the anode on M1 and the cathode in the supra-orbital region. Individuals with active bipolar TDCS will receive a 2mA stimulus for twenty minutes. Meanwhile, they will use the Regognise hand application to discriminate right/left side of hand images.

Group Type ACTIVE_COMPARATOR

TDCS

Intervention Type DEVICE

Technique of non-invasive brain stimulation by direct current (TDCS) which involves the modulation of excitability and brain activity, capable of promoting reorganization of the cortical representation of the body schema or motor planning, and consequently, pain relief.

Recognize (hand) - Laterality

Intervention Type DEVICE

This technique stimulates the ability to recognize hand images as right/left quicklPatients with chronic pain present delayed recognition of hand laterality, which is related to the duration of symptoms and the pain evoked by the execution of the movement. Thus, this technique can have beneficial effects in breaking the pain.

Active bipolar TDCS associated with landscape recognition stimuli

Participants will have carbon electrodes positioned, with contact through a 5x7cm sponge moistened in saline solution, with the anode on M1 and the cathode in the supra-orbital region. Individuals with active bipolar TDCS will receive a 2mA stimulus for twenty minutes.

At the same time, they will be guided to recognize landscapes that do not refer to the recognition of laterality.

Group Type ACTIVE_COMPARATOR

TDCS

Intervention Type DEVICE

Technique of non-invasive brain stimulation by direct current (TDCS) which involves the modulation of excitability and brain activity, capable of promoting reorganization of the cortical representation of the body schema or motor planning, and consequently, pain relief.

Landscape recognition

Intervention Type OTHER

Image recognition training that does not refer to right/left discrimination.

Sham TDCS associated with laterality recognition stimuli

Participants will have carbon electrodes positioned, with contact through a 5x7cm sponge moistened in saline solution, with the anode on M1 and the cathode in the supra-orbital region. Stimulation will remain inactive for the 20 minutes. Meanwhile, they will use the Regognise hand app to discriminate right/left hand images.

Group Type ACTIVE_COMPARATOR

Recognize (hand) - Laterality

Intervention Type DEVICE

This technique stimulates the ability to recognize hand images as right/left quicklPatients with chronic pain present delayed recognition of hand laterality, which is related to the duration of symptoms and the pain evoked by the execution of the movement. Thus, this technique can have beneficial effects in breaking the pain.

Sham TDCS

Intervention Type OTHER

TDCS sham: The device remains inactive for 20 minutes.

Sham TDCS associated with landscape recognition stimuli

Participants will have carbon electrodes positioned, with contact through a 5x7cm sponge moistened in saline solution, with the anode on M1 and the cathode in the supra-orbital region. Stimulation will remain inactive for the 20 minutes. At the same time, they will be guided to recognize landscapes that do not refer to the recognition of laterality.

Group Type PLACEBO_COMPARATOR

Sham TDCS

Intervention Type OTHER

TDCS sham: The device remains inactive for 20 minutes.

Landscape recognition

Intervention Type OTHER

Image recognition training that does not refer to right/left discrimination.

Interventions

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TDCS

Technique of non-invasive brain stimulation by direct current (TDCS) which involves the modulation of excitability and brain activity, capable of promoting reorganization of the cortical representation of the body schema or motor planning, and consequently, pain relief.

Intervention Type DEVICE

Recognize (hand) - Laterality

This technique stimulates the ability to recognize hand images as right/left quicklPatients with chronic pain present delayed recognition of hand laterality, which is related to the duration of symptoms and the pain evoked by the execution of the movement. Thus, this technique can have beneficial effects in breaking the pain.

Intervention Type DEVICE

Sham TDCS

TDCS sham: The device remains inactive for 20 minutes.

Intervention Type OTHER

Landscape recognition

Image recognition training that does not refer to right/left discrimination.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* participants over 18 years old;
* pain in the cervical region, lasting more than three months and with intensity greater than 40/100 on the visual analog scale

Exclusion Criteria

* history of seizures or epilepsy,
* history of head trauma,
* intracranial hypertension,
* intracranial metal clip,
* pregnant or breastfeeding women,
* skin lesions at the current application site;
* changes in sensitivity and allergy in the electrode positioning region.
* intermittent pain;
* Cancer;
* cardiac pacemaker;
* severe spinal diseases, such as recent fractures or ankylosing spondylitis;
* serious cardiorespiratory diseases;
* participants who refuse to sign the Free and Informed Consent Form.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Sao Paulo General Hospital

OTHER

Sponsor Role lead

Responsible Party

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Clarice Tanaka

Director, Principal investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Universidade de São Paulo

São Paulo, , Brazil

Site Status RECRUITING

Countries

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Brazil

Central Contacts

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Clarice Tanaka

Role: CONTACT

551126616867

Facility Contacts

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Clarice Tanaka, PhD

Role: primary

Other Identifiers

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94350518.6.0000.0068

Identifier Type: -

Identifier Source: org_study_id

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