Aftereffects of alpha transcranial alternating current stimulation over the primary sensorimotor cortex on cortical processing of pain

Alpha transcranial alternating current stimulation modulates pain anticipation and perception in a context-dependent manner

ABSTRACT

Pain perception is closely tied to the brain's anticipatory processes, particularly involving the suppression of sensorimotor α-oscillations, which reflect the system's readiness for incoming pain. Higher sensorimotor α-oscillation levels are correlated with lower pain sensitivity. Alpha transcranial alternating current stimulation (α-tACS) can enhance these oscillations, potentially reducing pain perception, with effects that may be sustained and influenced by the certainty of pain expectations. Hence, this study investigated the immediate and sustained effects of α-tACS on pain anticipation and perception, focusing on how these effects are shaped by the certainty of expectations. In a double-blind, sham-controlled design, 80 healthy participants underwent a 20-minute session of real or sham α-tACS over the right sensorimotor region. Behavioral and neural responses related to pain anticipation and perception were recorded before, immediately after, and 30 minutes poststimulation under both certain and uncertain conditions. Compared with sham stimulation, real α-tACS disrupted the habituation of laser-evoked potentials (N2-P2 complex), particularly under certain expectations, with effects persisting 30 minutes poststimulation. In anticipatory brain oscillations, real α-tACS enhanced somatosensory α1-oscillations and increased midfrontal θ-oscillations in conditions of certainty, with θ-oscillation modulation showing sustained effects. Mediation analysis revealed that α-tACS reduced pain reactivity by enhancing somatosensory α1-oscillations but increased pain reactivity through the enhancement of midfrontal θ-oscillations, with the latter effect being more pronounced. These findings suggest that while α-tACS may provide pain relief through somatosensory α-oscillation augmentation, its stronger and longer-lasting impact on midfrontal θ-oscillations could lead to hyperalgesia, particularly in the context of certain pain expectations.

Individual differences in resting alpha band power and changes in theta band power during sustained pain are correlated with the pain-relieving efficacy of alpha HD-tACS on SM1

High-definition transcranial alternating current stimulation (HD-tACS) targeting alpha rhythms (8-13 Hz) shows promise as a pain-relieving intervention, but individual responses vary widely. Understanding the neurobiological mechanism behind this variability is crucial for optimizing HD-tACS parameters to enhance its efficacy in pain relief. In a double-blind, within-subject, sham-controlled experimental study, 34 healthy participants were recruited. We investigated how individual differences in brain oscillations during rest and capsaicin-induced sustained pain states influence the efficacy of alpha HD-tACS. Participants underwent EEG assessments at rest and during capsaicin-induced sustained pain. They then received either sham or active HD-tACS on the sensorimotor cortex (SM1) or dorsolateral prefrontal cortex (DLPFC). We found significant reductions in delta and theta band power at the C4 electrode during sustained pain correlated with individual pain intensity. Additionally, stimulating the SM1 and DLPFC significantly relieved sustained pain. Resting alpha band power and changes in theta band power during sustained pain (the difference in theta band power between sustained pain and rest) at the C4 electrode were both significantly correlated with the pain-relieving efficacy of alpha HD-tACS on SM1. Notably, changes in theta band power mediated the relationship between resting alpha band power and pain-relieving efficacy. These results were not found with alpha HD-tACS on DLPFC. Our results suggest that the variations in theta band power during sustained pain may be crucial for understanding the variability in the efficacy of alpha HD-tACS targeting SM1. The factors influencing the efficacy of alpha HD-tACS on the DLPFC might be multifaceted.

Beta tACS of varying intensities differentially affect resting-state and movement-related M1-M1 connectivity

Due to the interconnected nature of the brain, changes in one region are likely to affect other structurally and functionally connected regions. Emerging evidence indicates that single-site transcranial alternating current stimulation (tACS) can modulate functional connectivity between stimulated and interconnected unstimulated brain regions. However, our understanding of the network response to tACS is incomplete. Here, we investigated the effect of beta tACS of different intensities on phase-based connectivity between the left and right primary motor cortices in 21 healthy young adults (13 female; mean age 24.30 ± 4.84 years). Participants underwent four sessions of 20 min of 20 Hz tACS of varying intensities (sham, 0.5 mA, 1.0 mA, or 1.5 mA) applied to the left primary motor cortex at rest. We recorded resting-state and event-related electroencephalography (EEG) before and after tACS, analyzing changes in sensorimotor beta (13-30 Hz) imaginary coherence (ImCoh), an index of functional connectivity. Event-related EEG captured movement-related beta activity as participants performed self-paced button presses using their right index finger. For resting-state connectivity, we observed intensity-dependent changes in beta ImCoh: sham and 0.5 mA stimulation resulted in an increase in beta ImCoh, while 1.0 mA and 1.5 mA stimulation decreased beta ImCoh. For event-related connectivity, 1.5 mA stimulation decreased broadband ImCoh (4-90 Hz) during movement execution. None of the other stimulation intensities significantly modulated event-related ImCoh during movement preparation, execution, or termination. Interestingly, changes in ImCoh during movement preparation following 1.0 mA and 1.5 mA stimulation were significantly associated with participants' pre-tACS peak beta frequency, suggesting that the alignment of stimulation frequency and peak beta frequency affected the extent of neuromodulation. Collectively, these results suggest that beta tACS applied to a single site influences connectivity within the motor network in a manner that depends on the intensity and frequency of stimulation. These findings have significant implications for both research and clinical applications.