Methods and strategies of tDCS for the treatment of pain: current status and future directions.

Introduction Transcranial Direct Current Stimulation (tDCS) is a non-invasive neuromodulation technique which has been widely studied for the treatment of chronic pain. It is considered a promising and safe alternative pain therapy. Different targets have been tested, each having their own particular mechanisms for modulating pain perception. Areas covered We discuss the current state of the art of tDCS to manage pain and future strategies to optimize tDCS' effects. Current strategies include primary motor cortex tDCS, prefrontal tDCS and tDCS combined with behavioral interventions while future strategies, on the other hand, include high intensity tDCS, transcutaneous Spinal Direct Current Stimulation, cerebellar tDCS, home-based tDCS and tDCS with extended number of sessions. Expert commentary It has been shown that the stimulation of the prefrontal and primary motor cortex is efficient for pain reduction while a few other new strategies, such as high intensity tDCS and network-based tDCS, are believed to induce strong neuroplastic effects, although the underlying neural mechanisms still need to be fully uncovered. Hence, conventional tDCS approaches demonstrated promising effects to manage pain and new strategies are under development to enhance tDCS effects and make this approach more easily available by using, for instance, home-based devices.