Neurostimulation and Neuromodulation for Pain and Spinal Dysfunction

*Neurostimulation and Neuromodulation in Contemporary Therapeutic Practice*

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10.3390/brainsci8080158

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**Chapter 9**

**Abstract**

Cerebellar Transcranial Direct

Current Stimulation (ctDCS)

*Tommaso Bocci, Roberta Ferrucci, Alberto Priori,* 

Transcranial direct stimulation (tDCS) in the treatment of intractable or marginally tractable pain is experiencing an increasing diffusion in many fields worldwide. Recently, new modality of tDCS application has been proposed and applied, as cerebellar transcranial direct current stimulation (ctDCS). Indeed, the cerebellum has been proved to play a role in pain processing and to be involved in a wide number of integrative functions. In this chapter, we encompass the history of the technique, analysis of principles, a general description, including the methodological procedures of ctDCS; then, main clinical applications and their main effects in perceptive threshold of pain and other sensation, pain intensity, and laser

**Keywords:** cerebellum, tDCS, cerebellar stimulation, pain, phantom limb pain

Pain still remains a challenge for clinicians and neuroscientists, and current pharmacological therapies are often ineffective for the prevention and treatment of chronic pain. In particular, chronization of pain represents a multi-step phenomenon, comprising spinal phenotypic switch in the expression of neuropeptides, as well as elusive brain mechanisms, ranging from the so-called "thalamo-cortical dysrhythmia" to a functional reorganization of sensorimotor maps (**Figure 1**) [1–4]. In this scenario, the putative relationship between pain and the cerebellum is particularly intriguing, as the cerebellum is anatomically located between the spinal cord and the brain, possibly interfering both with top-down and bottom-up mechanisms underlying pain control and ultimately responsible for central pain

The cerebellum is involved in a wide range of integrative functions, ranging from motor adaptation to working memory and associative learning, but its role in

Overall, the cerebellum likely belongs to a widespread network that mediates reactions stronger to negative external stimuli than to positive ones [11, 12]; recent

nociceptive experience and pain processing remains debated [5–10].

*Massimiliano Valeriani and Ferdinando Sartucci*

Effect in Perception and

Modulation of Pain

evoked potentials (LEPs) changes.

**1. Introduction**

sensitization.
