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Background <p>Although effectively controlling inflammation, up to 50% of patients with rheumatoid arthritis (RA) experience persistent pain, associated with central sensitization and neuroinflammation. Home-based transcranial direct current stimulation (tDCS) has shown efficacy in chronic pain.</p> Objective <p>To investigate whether anodal tDCS (a-tDCS) is more effective than sham stimulation in reducing pain.</p> Methods <p>Randomized, double-blind, sham-controlled trial with 34 women (18–70 years) with RA and VAS &gt; 40&#xa0;mm. Participants were randomized to receive a-tDCS (<i>n</i> = 17) or sham tDCS (<i>n</i> = 17). Home-based tDCS (2&#xa0;mA, 20&#xa0;min/day) or sham (2&#xa0;mA, 90&#xa0;s) for four weeks, using anodal-left M1 montage. Primary outcomes was pain (Visual Analogue Scale, VAS), Secondary outcomes included pressure pain threshold (PPT), central sensitization (CSI), physical function (HAQ-DI), fatigue (FACIT-F), CNS biomarkers, adherence, and safety.</p> Results <p>Mean VAS reduction from baseline was greater in the a-tDCS group (-33.5&#xa0;mm) versus s-tDCS (-14.1&#xa0;mm), with a between-group difference of -19.4&#xa0;mm (95% CI, -29.3 to -9.5; <i>p</i> = 0.003). Linear mixed-effects models showed that a-tDCS reduced VAS pain by 27.7% versus 6.0% with sham, a between-group difference of 21.7% (Cohen’s d = 1.15). HAQ-DI improved by 38.0% versus 7.2% (ES = 1.10). a-tDCS reduced analgesic use by 62% (RR = 0.38; 95% CI, 0.18–0.79). Exploratory analyses suggested that neuroplasticity mechanisms might mediate these effects.</p> Conclusion <p>Home-based a-tDCS effectively reduced pain, disability, and analgesic use in RA patients with persistent pain without objective inflammation.</p>

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Home-based transcranial direct current stimulation for persistent pain state in rheumatoid arthritis: a randomized trial

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月20日

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  • Stephanie Pilotti,
  • Lucas Denardi Dória,
  • Maria Luisa Gasparini,
  • Natália Garcia dos Santos,
  • Barbara Regina França,
  • André Luiz Silveira Mallmann,
  • André Lucas Ribeiro,
  • Leonardo Peterson dos Santos,
  • Daniel Nóbrega de Moraes,
  • Rafaela Cavalheiro do Espírito Santo,
  • Claiton Viegas Brenol,
  • Iraci L. S. Torres,
  • Wolnei Caumo,
  • Ricardo Machado Xavier

摘要

Background

Although effectively controlling inflammation, up to 50% of patients with rheumatoid arthritis (RA) experience persistent pain, associated with central sensitization and neuroinflammation. Home-based transcranial direct current stimulation (tDCS) has shown efficacy in chronic pain.

Objective

To investigate whether anodal tDCS (a-tDCS) is more effective than sham stimulation in reducing pain.

Methods

Randomized, double-blind, sham-controlled trial with 34 women (18–70 years) with RA and VAS > 40 mm. Participants were randomized to receive a-tDCS (n = 17) or sham tDCS (n = 17). Home-based tDCS (2 mA, 20 min/day) or sham (2 mA, 90 s) for four weeks, using anodal-left M1 montage. Primary outcomes was pain (Visual Analogue Scale, VAS), Secondary outcomes included pressure pain threshold (PPT), central sensitization (CSI), physical function (HAQ-DI), fatigue (FACIT-F), CNS biomarkers, adherence, and safety.

Results

Mean VAS reduction from baseline was greater in the a-tDCS group (-33.5 mm) versus s-tDCS (-14.1 mm), with a between-group difference of -19.4 mm (95% CI, -29.3 to -9.5; p = 0.003). Linear mixed-effects models showed that a-tDCS reduced VAS pain by 27.7% versus 6.0% with sham, a between-group difference of 21.7% (Cohen’s d = 1.15). HAQ-DI improved by 38.0% versus 7.2% (ES = 1.10). a-tDCS reduced analgesic use by 62% (RR = 0.38; 95% CI, 0.18–0.79). Exploratory analyses suggested that neuroplasticity mechanisms might mediate these effects.

Conclusion

Home-based a-tDCS effectively reduced pain, disability, and analgesic use in RA patients with persistent pain without objective inflammation.