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Larissa Ramalho Dantas Varella Dutra,1 Rodrigo Pegado,2 Luana Karyne Silva,2 Hégila da Silva Dantas,2 Hialison Andrade Câmara,2 Edson Meneses Silva-Filho,2 Grasiéla Nascimento Correia,2 Maria Thereza Albuquerque Barbosa Cabral Micussi1 1Health Science Center, Federal University of Rio Grande do Norte, Rio Grande do Norte, Brazil; 2Graduate Program in Rehabilitation Science, Federal University of Rio Grande do Norte, Rio Grande do Norte, BrazilCorrespondence: Edson Meneses Silva-FilhoFaculdade de Ciências da Saúde do Trairi - Universidade Federal do Rio Grande do Norte, FACISA/UFRN, Rua Teodorico Bezerra, Santa Cruz, RN 59200-000, BrazilTel +55 81 99470 6661Email meneses.edson@yahoo.com.brBackground: Primary dysmenorrhea is a common and often debilitating condition affecting 40– 90% of menstruating women. This condition reduces functionality, quality of life, and social activities. Transcranial direct current stimulation (tDCS) has been used in many chronic pain syndromes, with evidence of improved pain, functionality, and moodin women with primary dysmenorrhea.The objective of this study was to determine whether tDCS could offer clinical benefits on pain, anxiety, affectivity, and functionality in women with primary dysmenorrhea.Methods: This parallel, sham, randomized, double-blind trial was conducted with 26 women randomized into shamtDCS and activetDCS. Anodal tDCS was applied for 5 consecutive days over F3 corresponding to theleft dorsolateral prefrontal cortex (DLPFC) and thecathode electrode over Fp2 for 20min with an intensity of 2mA. A numeric rating scale(NRS) was used to assess pain, anxiety, positive and negative affect, and submaximal aerobic performance during two consecutive menstrual cycles.Results: No significant interaction was found between intervention and time on theNRS [F(2,44) = 1.358, p= 0.26], and asignificant main effect of time [F(2,44) = 4.446, p= 0.01] was found. The active group showed a significant reduction in anxiety (p= 0.03) with a mean difference of 5.12 (95% CI 0.79 to 11.05). No significant differences in positive and negative affect were found (p = 0.95 and p= 0.15, respectively). Submaximal aerobic performance was significantly greater in theactive group [F(2,21) = 5.591, p= 0.02], with a mean difference of 70.87 (95% CI 8.53 to 133.21).Conclusion: Anodal tDCS over theDLPFC seems to be an effective therapeutic approach for improving anxiety and functionality in women with primary dysmenorrhea.Keywords: non-invasive brain stimulation, menstrual cycle, pain, anxiety, functional capacity

BACKGROUND AND OBJECTIVES: Fibromyalgia (FM) is a chronic widespread musculoskeletal pain resulting in central sensitization of nociceptive signaling. Transcranial direct current stimulation (tDCS) over the left motor cortex (M1) is a non-invasive neuromodulation technique indicated for a broad range of chronic pain disorders, including FM. Studies suggest that left and right M1 (contralateral and ipsilateral hemisphere of tDCS stimulation) are modulated. But it is necessary to clarify the differences in clinical pain perception comparing the right and left side of the body. This study aimed to evaluate the pain-related difference between right-left side of the body after five sessions of anodal tDCS in women with FM. METHODS: A double-blinded, parallel, randomized, sham-controlled trial with 30 women with FM was performed. Five sessions of anodal C3 and cathodal supraorbital (Fp2) tDCS were conducted (2 mA for 20 min). Pain, impact of FM and anxiety were evaluated. No statistically significant three-way interaction between time, stimulation type and body side were found. RESULTS: Active-tDCS showed significant improvement in pain, but impact of FM and anxiety did not show significant improvement. CONCLUSION: Five sessions of anodal tDCS over the left M1 improves pain in women with FM, however there was no difference between right-left body sides. RESUMO JUSTIFICATIVA E OBJETIVOS: A fibromialgia (FM) é uma dor musculoesquelética crônica generalizada que resulta na sensibilização central da sinalização nociceptiva. A estimulação transcraniana de corrente contínua (eTCC) sobre o córtex motor esquerdo (M1) é uma técnica de neuromodulação não invasiva indicada para uma ampla gama de distúrbios de dor crônica, incluindo a FM. Estudos sugerem a modulação do M1 esquerdo e direito (hemisfério contralateral e ipsilateral da eTCC). Mas é necessário esclarecer as diferenças na percepção clínica da dor comparando os lados direito e esquerdo do corpo. Este estudo teve como objetivo avaliar a diferença relacionada à dor entre o lado direito e esquerdo do corpo após cinco sessões de eTCC anodal em mulheres com FM. MÉTODOS: Foi realizado um estudo duplo-cego, paralelo, randomizado e controlado por sham com 30 mulheres com FM. Foram realizadas cinco sessões de eTCC anodais C3 e supraorbitais catodais (Fp2) (2 mA por 20 min). Foram avaliados a dor, o impacto da FM e a ansiedade. Não foi encontrada nenhuma interação de três vias estatisticamente significativa entre tempo, tipo de estimulação e lado do corpo. RESULTADOS: A eTCC-Ativa mostrou uma melhora significativa na dor, mas o impacto da FM e da ansiedade não mostrou uma melhora significativa. CONCLUSÃO: Cinco sessões de eTCC anodal sobre o M1 esquerdo melhoram a dor nas mulheres com FM, entretanto não houve diferença entre os lados direito e esquerdo do corpo.

Introduction: Several non-pharmacological strategies have been used to manage blood pressure (BP) in hypertensive individuals, including physical exercise which reduces BP by decreasing sympathetic hyperactivity and vascular dysfunction. In the scope of non-invasive techniques, transcranial direct current stimulation (TDCS) stands out as a safe intervention to treat several clinical conditions, however, its effectiveness to potentiate the effects of physical exercise on hypertensive people have not yet been tested. Objective: To assess whether tDCS can enhance the effects of physical exercise on BP and heart rate variability in hypertensive individuals. Methods: A randomized controlled clinical trial that included individuals with arterial hypertension (systolic blood pressure >120 80 120 80 120 80

O vírus da Chikungunya (CHIK) é uma epidemia no Brasil com 170.000 casos no primeiro semestre de 2016. Mais de 60% dos pacientes apresentam reação e remissão de artralgia crônica com dor debilitante que dura anos. Não existem agentes terapêuticos específicos para tratar e reabilitar pessoas infectadas com CHIK. Dor persistente pode levar à incapacitação exigindo tratamento farmacológico de longo prazo. Os avanços nos tratamentos não farmacológicos são necessários para promover o alívio da dor sem efeitos colaterais e restaurar a funcionalidade. Aqui, nós demonstramos que a Estimulação Transcraniana com Corrente Contínua (ETCC) sobre o córtex motor primário reduz significativamente a dor na fase crônica da CHIK. Nossos achados sugerem que a ETCC pode ser uma terapia eficaz, barata e implantável em áreas que não possuem recursos e que apresentam um grande número de pacientes com dor crônica persistente gerada pela CHIK. The Chikungunya (CHIK) virus is epidemic in Brazil, with 170,000 cases in the first half of 2016. More than 60% of patients present relapsing and remitting chronic arthralgia with debilitating pain lasting years. There are no specific therapeutic agents to treat and rehabilitee infected persons with CHIK. Persistent pain can lead to incapacitation, requiring long-term pharmacological treatment. Advances in non-pharmacological treatments are necessary to promote pain relief without side effects and to restore functionality. Here, we demonstrate that the transcranial direct current stimulation (tDCS) across the primary motor cortex significantly reduces pain in the chronic phase of CHIK. Our findings suggest tDCS could be an effective, inexpensive and deployable therapy to areas lacking resources with a great number of patients with chronic CHIK persistent pain.