Clinical trial NCT06994390: Neuropathic Pain Intervention With tDCS in Brazilian Military Personnel (NeuBRAIN Trial)
Official title: Neuropathic Pain Intervention With tDCS in Brazilian Military Personnel Randomized Controlled Trial
Study type: INTERVENTIONAL
Overall status: NOT_YET_RECRUITING
Phase: NA
Conditions: Neuropathic Pain
Sleep Quality
Transcranial Direct Current Stimulation
Keywords: transcranial current stimulation
neuropathic pain
sleep
Lead sponsor: Hospital da Polícia Militar de Goiás
Sponsor class: NETWORK
Collaborators: name: Hospital das Clínicas de São Paulo - SP
First posted: 2025-05-29
Enrollment: 120
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: The intervention will be carried out into two-weeks daily consecutive sessions of 20 minutes each, with 1 session/day, and a weekend interval. Direct current stimulation will be administered through an electrical stimulator model MicroEstim Genius (NKL), Brusque, Brazil. During the session, the participants will be awake and seated in a comfortable seat. The environment will be air-conditioned, free of visual and auditory stimuli.

The sessions will be conducted by a trained health professional. The groups will receive single-phase direct current with an intensity of 2 mA up, according to data presented by Pacheco-Barrios et al. (2021). Electrodes with a size of 35cm² (5 x 7 centimeters) will be used. Electrodes will be placed on the scalp, fixed with elastic bands, and immersed in 10 to 12 mL of saline solution.

The electrode montage will be performed for one of two possible targets: anodal stimulation over DLPFC or anodal stimulation over M1, and also sham in both targets.
Primary purpose: TREATMENT

Brief summary: This project protocol investigates the efficacy of transcranial direct current stimulation (tDCS) in treating neuropathic pain and improving sleep quality among Brazilian military personnel. Given the high prevalence of chronic pain and sleep disturbances in this population, and the limitations of current pharmacological treatments, our randomized, triple-blinded, sham-controlled trial explores the potential of tDCS as a non-invasive therapeutic intervention. The results of this study could have a significant impact on improving the well-being and performance of military personnel, while also reducing healthcare costs associated with long-term medication use.

Detailed description: The intervention will be carried out into two-weeks daily consecutive sessions of 20 minutes each, with 1 session per day, and a weekend interval. Direct current stimulation will be administered through an electrical stimulator model MicroEstim Genius (NKL), Brusque, Brazil. During the session, the participants will be awake and seated in a comfortable seat. The environment will be air-conditioned, free of visual and auditory stimuli.

The sessions will be conducted by a trained health professional. The groups will receive single-phase direct current with an intensity of 2 mA up, according to data presented by Pacheco-Barrios et al. (2021). Electrodes with a size of 35cm² (5 x 7 centimeters) will be used. Electrodes will be placed on the scalp, fixed with elastic bands, and immersed in 10 to 12 mL of saline solution.

The electrode montage will be performed for one of two possible targets: anodal stimulation over DLPFC or anodal stimulation over M1, and also sham in both targets according to the participants' designations after randomization to one of the three groups.

The device displays will be identical across active and sham groups, and to ensure blinding, an active current will be applied for 30 seconds at the beginning and end of the sham stimulation to mimic the sensation of the current ramp experienced in active stimulation. Stimulations of less than 3 minutes of tDCS do not induce cortical excitability effects, according to Nitsche and Paulus (2000), being safely inactive for the expected results.

Eligibility criteria: Inclusion criteria:

* Military personnel (active and veterans) with chronic pain due to central or peripheral neuropathy and poor sleep quality;
* Age over 18 years old;
* Defined chronic NeP according to current guidelines (ICD-10 codes OR DN-4);
* Pain with an average intensity score above 40/100 mm on a visual analogue scale (VAS);
* Medication stability (chronic pain, depression, anxiety, sleep) for at least six weeks;
* Patients with bad sleep quality identified by the Pittsburgh Sleep Quality Index (PSQI) of 5 or more who do not improve under conventional treatment.

Exclusion criteria:

* General contraindications for tDCS: past head trauma, current epilepsy, intracranial ferromagnetic components, pacemaker, implanted microprocessors (i.e., cochlear implants);
* Pregnancy;
* Known major psychiatric disorders (as assessed by the DSM-5, e.g., psychosis), history of substance abuse, or work litigation issues;
* History of chronic refractory migraines;
* Non-treated moderate to severe sleep apnea defined as apnea/hypopnea index greater than 15 events per hour in baseline polysomnography;
* Skin conditions such as psoriasis or eczema that involve the scalp (Thair et al, 2017);
* Cancer-related pain;
* BMI \>35, due to increased reports of pain associated with increased BMI (Basem, et al., 2021; Stokes et al., 2020);
* Patients who do not sign informed consent or do not want to participate in the study.

Primary outcomes:
measure: pain intensity by VAS
timeFrame: at baseline, at the end of the ten-day treatment and at follow-up, three weeks post-intervention.
Secondary outcomes:
measure: Pittsburgh Sleep Quality Index (PSQI)
timeFrame: It will be measured at baseline, at the end of the ten-day treatment and at follow-up, three weeks post-intervention.
measure: Epworth Sleepiness Scale (ESS)
timeFrame: at baseline, at the end of the ten-day treatment and at follow-up, three weeks post-intervention.
measure: the Visual Analogue Scale for Fatigue Severity (VAS-F)
timeFrame: measured at baseline, at the end of the ten-day treatment and at follow-up, three weeks post-intervention.
measure: Polysomnographic evaluation - time
timeFrame: PSG will be measured at baseline and at the end of the ten-day treatment.
measure: Polysomnographic evaluation - arousal index
timeFrame: PSG will be measured at baseline and at the end of the ten-day treatment.
measure: Polysomnographic evaluation - sleep efficiency
timeFrame: PSG will be measured at baseline, at the end of the ten-day treatment.
measure: Polysomnographic evaluation- sleep stages
timeFrame: at baseline, at the end of the ten-day treatment.
measure: Polysomnographic evaluation- PLMI
timeFrame: PSG will be measured at baseline, at the end of the ten-day treatment.
Other outcomes:
measure: Pittsburgh Sleep Quality Index Addendum for Posttraumatic Stress Disorder (PSQI-A)
timeFrame: at baseline and at the end of 10-day treatment
measure: the Depression-Anxiety-Stress Scales-21 (DASS-21)
timeFrame: at baseline and at the end of 10-day treatment
measure: Sociodemografic characteristics - DOB
timeFrame: at baseline
measure: Sociodemografic characteristics - age
timeFrame: at baseline
measure: Sociodemografic characteristics - educational level
timeFrame: at baseline
measure: Sociodemografic characteristics - marital status
timeFrame: at baseline
measure: Sociodemografic characteristics - previous diseases
timeFrame: at baseline
measure: Sociodemografic characteristics - medication use
timeFrame: at baseline
measure: Sociodemografic characteristics- weight
timeFrame: at baseline
measure: sociodemografic characteristics- height
timeFrame: at baseline
Locations:
city: Goiânia
country: Brazil
facility: Hospital da Polícia Militar de Goiás
state: Goiás
Study officials:
affiliation: São Paulo University
name: Clarissa Bueno, MD, PhD
role: STUDY_DIRECTOR
References:
citation: Fregni F, Boggio PS, Lima MC, Ferreira MJ, Wagner T, Rigonatti SP, Castro AW, Souza DR, Riberto M, Freedman SD, Nitsche MA, Pascual-Leone A. A sham-controlled, phase II trial of transcranial direct current stimulation for the treatment of central pain in traumatic spinal cord injury. Pain. 2006 May;122(1-2):197-209. doi: 10.1016/j.pain.2006.02.023. Epub 2006 Mar 27.
citation: Nitsche MA, Paulus W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol. 2000 Sep 15;527 Pt 3(Pt 3):633-9. doi: 10.1111/j.1469-7793.2000.t01-1-00633.x.
citation: Mehta S, McIntyre A, Guy S, Teasell RW, Loh E. Effectiveness of transcranial direct current stimulation for the management of neuropathic pain after spinal cord injury: a meta-analysis. Spinal Cord. 2015 Nov;53(11):780-5. doi: 10.1038/sc.2015.118. Epub 2015 Jul 21.
citation: Pacheco-Barrios K, Cardenas-Rojas A, Thibaut A, Costa B, Ferreira I, Caumo W, Fregni F. Methods and strategies of tDCS for the treatment of pain: current status and future directions. Expert Rev Med Devices. 2020 Sep;17(9):879-898. doi: 10.1080/17434440.2020.1816168. Epub 2020 Sep 15.
citation: Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole MR. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001 Nov;94(2):149-158. doi: 10.1016/S0304-3959(01)00349-9.