Efecto de la hipnosis combinada con estimulación transcraniana de corriente continua en la percepción del dolor y en la función del sistema descendente en sujetos sanos : ensayo clínico randomizado ciego cruzado controlado con uso simulado

Introducción: El dolor es un problema de salud pública, asociado al sufrimiento y la incapacidad funcional. Sus consecuencias permanecen en la vida personal y social del paciente, llevando a cambios significativos en sus relaciones interpersonales, laborales, familiar y social, disminuyendo la capacidad para realizar las actividades diarias. Las técnicas farmacológicas tienes resultados parciales en los pacientes, muchos de ellos acaban por convertirse en pacientes polimedicados y refractarios al tratamiento. Las técnicas no farmacológicas son promisorias y tienen evidencia científica positivas en el efecto del dolor, teniendo mayores estudios en los últimos años con técnicas como electroacupuntura. estimulación magnética transcraneana, estimulación transcraneana de corriente continua, terapia cognitiva conductual y hipnosis. Entre las que se destacan es la estimulación transcraniana de corriente continua (ETCC) y la sugestion a la analgesia hipnótica. Considerando las limitaciones de las opciones farmacológicas en el tratamiento de dolores crónicos, nuevas investigaciones deben orientarse a propiciar el avance en el proceso y comprensión de los mecanismos del dolor y proporcionar nuevas posibilidades terapéuticas con el potencial de modificar los procesos de neuroplasticidad disfuncional asociados al dolor crónico. Objetivo: Los objetivos fueron dos: (I) Determinar si la sugerencia de analgesia hipnótica y la estimulación transcraniana de corriente continua (ETCC) tienen un efecto diferencial en la percepción del dolor. Planteamos la hipótesis de que la estimulación transcraniana de corriente continua sería más efectiva que la analgesia hipnótica para cambiar el sistema de modulación del dolor descendente, mientras que la sugestión hipnótica tendría un mayor efecto en las pruebas sensoriales cuantitativas. (ii) Pretende comprender el efecto combinado de la estimulación de corriente continua transcraneal (a-ETCC) y la sugerencia de analgesia hipnótica sobre la percepción del dolor y el sistema de modulación del dolor descendente (SMDD). Esta investigación también pretende determinar si el efecto de a-ETCC y la sugerencia de analgesia hipnótica en las medidas psicofísicas (CPM-task, HPT, HPTo y CPT) podría asociarse con el nivel sérico de BDNF. Planteamos la hipótesis de que la terapia combinada (a-ETCC / sugerencia hipnótica) presentaría más efectividad en la percepción del dolor y SMDD que las intervenciones individuales (a-ETCC o sugerencia hipnótica). Métodos: Se incluyeron mujeres sanas de 18 a 45 años, con una alta susceptibilidad a la hipnosis, según la Escala de susceptibilidad hipnótica de Waterloo-Stanford Group, Forma C . Los sujetos recibieron una estimulación de corriente continua transcraneal anodal (a-ETCC) sobre DLPFC izquierdo (2 mA durante 20 min) y analgesia hipnótica (20 min). En estudio I: Se incluyeron 24 mujeres aleatorizados y asignados en uno de los dos grupos de intervención con una distribución cruzada para uno del los grupos: (1) a-ETCC (2mA, 20min) e (2) Sugerencia hipnótica (20min). En estudio II: Se incluyeron 48 mujeres aleatorizados y asignados en uno de los cuatro grupos de intervención: (1) a-ETCC (2mA, 20min), (2) Sugerencia hipnótica (20min), (3) a-ETCC / Sugerencia hipnótica (2mA, 20min) o (4) s-ETCC / Sugerencia hipnótica (0mA, 20min). Después de la primera intervención, los participantes regresaron para una segunda sesión experimental para recibir una intervención alternativa. El grupo 1 pasó a recibir la intervención del grupo 2 y viceversa. Lo mismo se aplicó entre el grupo 3 y 4. Resultados: Los resultados del estudio I revelaron que solo la sugerencia hipnótica produjo cambios que son estadísticamente significativos desde antes de la intervención hasta después de la intervención en las siguientes medidas: umbral de dolor por calor, tolerancia al dolor por calor, prueba de presión en frío y factor Neurotrófico derivado del cerebro en suero. El análisis mostró un efecto principal significativo para el tratamiento (F = 4.32; P = 0.04) cuando comparamos la tarea delta- (Δ) de la modulación condicionada del dolor entre los grupos de estimulación transcraniana de corriente continua y de sugerencia hipnótica. Además, el cambio en el factor Neurotrófico derivado del cerebro se correlacionó positivamente con la tarea de modulación del dolor condicionada. Los resultados de estudio II demostraron que la sugerencia de hipnosis sola o combinada para a- o s-ETCC ha demostrado reducir la eficiencia del sistema de modulación del dolor descendente cuando se compara con a-ETCC solamente. El uso de a-ETCC mejoró el SMDD en un 53,70% en comparación con a-ETCC / Sugerencia hipnótica. La sugerencia hipnótica combinada con a-ETCC o s-ETCC aumentó el HPTo cuando se comparó con a-ETCC solo. Mientras que en s-ETCC / Sugerencia hipnótica aumentó HPTo casi 16 veces. La combinación de a-ETCC y la sugerencia hipnótica aumentó el CPT casi seis veces en comparación con a-ETCC solo y en un 156% en comparación con la sugerencia hipnótica solamente. Además, los niveles más altos de BDNF en la línea de base se correlacionaron positivamente con un cambio mayor en el valor de CPTo en el a-ETCC y en el CPT con a-ETCC / Sugerencia hipnótica. Conclusiones: Los resultados confirman un efecto diferencial entre la sugerencia hipnótica y la estimulación de corriente directa transcraneal en las medidas del dolor. Sugieren que el impacto de las intervenciones tiene mecanismos neurales diferenciales, ya que la sugerencia hipnótica mejoró la percepción del dolor, mientras que la estimulación transcraniana de corriente continua aumentó la inhibición del sistema de modulación del dolor descendente. Mientras que el efecto combinado no mejoró la eficiencia de la inhibición en el SMDD.Pain is a public health problem, associated with suffering and functional disability. Its consequences remain in the personal and social life of the patient, leading to significant changes in their interpersonal, work, family and social relationships, decreasing the ability to perform daily activities. Pharmacological techniques present a poor therapeutic response in most patients, many of them end up becoming polymedicated and refractory to treatment. The nonpharmacological techniques are promising and have positive scientific evidence of its effects on pain, with an increase in the number of studies with neuromodulatory techniques such as acupuncture, electroacupuncture, TMS, tDCS and hypnosis. Among those that stand out most are the transcranial direct current stimulation (ETCC) and the hypnotic analgesia suggestion. Considering the limitations of pharmacological options in the treatment of chronic pain, new research should be oriented to promote progress in the process and understanding of the mechanism of pain, providing new therapeutic possibilities with the potential to modify the dysfunctional neuroplasticity processes associated with chronic pain, aiming at clinical improvement. Objectives: There were two objectives: (I) To determine whether the suggestion of hypnotic analgesia and the transcranial direct current stimulation (tDCS) have a differential effect on the perception of pain. We hypothesized that transcranial direct current stimulation would be more effective than hypnotic analgesia in changing the descending pain modulating system (DPMS), whereas hypnotic suggestion would have a greater effect on quantitative sensory tests. (ii) Understand the combined effect of transcranial direct current stimulation (a tDCS) and the hypnotic analgesia suggestion on pain perception and the descending pain modulating system. This research also aims to determine if the effect of a-tDCS and the suggestion of hypnotic analgesia in psychophysical measures (CPM-task, HPT, HPTo and CPT) could be associated with the serum level of BDNF. We hypothesized that the combined therapy (a-tDCS / hypnotic analgesia suggestion) would be more effective in pain perception and DPMS than individual interventions (a-tDCS or hypnotic analgesic suggestion). Methods: Healthy women aged 18 to 45 years were included, with a high susceptibility to hypnosis, according to the Waterloo-Stanford Group hypnotic susceptibility scale, Form C. Subjects received an anodal transcranial direct current stimulation (a-tDCS) on left DLPFC (2 mA for 20 min) and hypnotic analgesia (20 min). In study I: 24 randomized and assigned women were included in one of the two intervention groups with a cross-sectional distribution for one of the groups: (1) a-tDCS (2mA, 20min) or (2) Hypnotic suggestion (20min). In study II: 48 randomized and assigned women were included in one of the four intervention groups: (1) atDCS (2mA, 20min), (2) Hypnotic analgesia suggestion (20min), (3) a-tDCS / Hypnotic analgesia suggestion (2mA, 20min) or (4) s-tDCS / Hypnotic analgesia suggestion (0mA, 20min). After the first intervention, the participants returned for a second experimental session to receive an alternative intervention. Group 1 went on to receive group 2 intervention and vice versa. The same was applied between group 3 and 4. Results: The results of the study I revealed that only the hypnotic suggestion produced changes that are statistically significant from pre to pos intervention in the following measures: heat pain threshold, heat pain tolerance, cold pressure test and neurotrophic factor derived from the brain in serum. The analysis showed a significant main effect for the treatment (F = 4.32, P = 0.04) when we compared the delta (Δ) task of the conditioned pain modulation between the groups of transcranial direct current stimulation and hypnotic suggestion. In addition, the change in the neurotrophic factor derived from the brain correlated positively with the task of conditioned pain modulation. The results of study II demonstrated that hypnotic suggestion alone or combined with a- or s-tDCS has been shown to reduce the efficiency of the descending pain modulation system when compared to a-tDCS alone. The use of a-tDCS improved the DPMS by 53.70% compared to a-tDCS / Hypnotic suggestion. The hypnotic suggestion combined with a-TDCS or s-TDCS increased the HPTo when compared with a-TDCS alone. While in s-tDCS / Hypnotic suggestion HPTo increased almost 16 times. The combination of a-tDCS and the hypnotic suggestion increased the CPT by almost six times compared to a-tDCS alone and by 156% compared to the hypnotic suggestion alone. In addition, the highest levels of BDNF in the baseline correlated positively with a greater change in the CPTo value in the a-tDCS and in the CPT with a-tDCS / Hypnotic suggestion. Conclusions: The results confirm a differential effect between hypnotic suggestion and transcranial direct current stimulation in pain measurements. They suggest that the impact of the interventions has differential neural mechanisms, since the hypnotic suggestion improved the perception of pain, whereas the stimulation by transcranial direct current increased the inhibition of the descending pain modulating system. While the combined effect did not improve the efficiency of inhibition in the DPMS

The McGill Quality of Life Questionnaire-Revised (MQOL-R) : psychometric properties and validation of a Brazilian version on palliative care patients : a cross-sectional study

Background: To assess the psychometric properties, including internal consistency, construct validity, criterion validity, criterion-group validity, and responsiveness, the Reviewed McGill Quality of Life Questionnaire (MQOL-R), into Brazilian Portuguese-(BrP). Also, to analyze the relationship of the BrP-MQOL-R with the scores on the Karnofsky Performance Scale (KPS) and on the Numerical Pain Scale (NPS 0–10). Methods: The BrP-MQOL-R was administered to a sample of 146 adults (men=78). A team of experts translated the MQOL-R according to international guidelines. Convergent validity and Confrmatory factor analysis (CFA) was performed. Results: The BrP-MQOL-R Cronbach’s alpha was 0.85. CFA supported the original four-factor structure, with the following revised model ft-indices: PCLOSE=0.131, Tucker-Lewis Index (TLI) rho 2=0.918, incremental ft index (IFI) delta 2=0.936. The convergence validity is supported by a signifcant correlation between BrP-MQOL-R total scores and their subscales with KPS and with the single item related to the quality of life. And by a converse correlation with the pain scores in the NPS (0–10). Receiver operator characteristics (ROC) analysis showed subjects with KPS equal to or lower than 30% could be discriminated from those with scores on KPS higher than 30% by an area under the curve (AUC)=0.71, sensitivity=97%, and specifcity=92%). Conclusion: The BrP-MQOL-R proves to be a reliable instrument for assessing the quality of life (QOL) in palliative care (PC), with primary evidence of validity. BrP-MQOL-R presented adequate discriminate properties to identify distinct conditions that impact the QOL in PC

The hypnotic analgesia suggestion mitigated the effect of the transcranial direct current stimulation on the descending pain modulatory system : a proof of concept study

Objective: We evaluated whether active(a)-tDCS combined with hypnotic analgesia suggestion (HS) would be more effective than a single active(a)-tDCS, and/or sham-(s)-tDCS and s-tDCS/HS on the following outcomes: function of descending pain modulatory system (DPMS) during the conditioned pain modulation test (CPM-test) (primary outcome), heat pain threshold (HPT), heat pain tolerance (HPTo) and cold pressor test (CPT) (secondary outcomes). We also examined whether their effects are related to neuroplasticity state evaluated by serum brain-derived-neurotropic factor (BDNF). Materials and Methods: Forty-eight females received one session of one of the four interventions (a-tDCS/HS, s-tDCS/HS, a-tDCS, and s-tDCS) in an incomplete randomized crossover sequence. The a-tDCS or s-tDCS was applied over the left dorsolateral prefrontal cortex (DLPFC) for 30 minutes at 2mA. Results: A generalized linear model revealed a significant main effect for the intervention group (P <0.032). The delta-(Δ) pain score on the Numerical Pain Scale (NPS0-10) during CPM-test in the a-tDCS/HS group was −0.25 (0.43). The (Δ) pain score on NPS (0–10) during CPM-test in the other three groups was a-tDCS=−0.54 (0.41), HS −0.01 (0.41) and stDCS/HS=−0.19 (0.43). A-tDCS/HS intervention increased the CPT substantially compared to all other interventions. Also, higher baseline levels of BDNF were associated with a larger change in CPT and HPTo. Conclusion: These findings indicate that the HS combined with a-tDCS mitigated the effect of the a-tDCS on the DPMS. The a-tDCS up-regulates the inhibition on DPMS, and the HS improved pain tolerance. And, together they enhanced the reaction time substantially upon the CPT

The fear of pain questionnaire : psychometric properties of a Brazilian version for adolescents and its relationship with brain-derived neurotrophic factor (BDNF)

Objectives: The primary aim was to assess the psychometric properties (including internal consistency, construct validity, criterion validity, criterion-group validity and responsiveness) of the Fear of Pain Questionnaire (FOPQ) for adolescents (FOPQ-A) and parents (FOPQ-P) translated to Brazilian Portuguese (BrP). The secondary aim was to analyze the factor structures and their ability to identify subjects with chronic pain conditions and identify the relationship of the BrP FOPQ-A with saliva brain-derived neurotrophic-factor (BDNF). Methods: A cross-sectional study was conducted with 286 adolescents aged 11 to 18 (257 healthy adolescents [157 females] and 29 adolescents with chronic pain [16 females]). Parents and adolescents completed the BrP-FOPQ. A team of experts translated the FOPQ according to international guidelines. Convergent validity and factor analysis were performed. Later, a subsample (n=146) was used to correlate the BrP-FOPQ-A with saliva BDNF. Results: The BrP-FOPQ for adolescents and parents presented strong psychometric properties (Cronbach’s α equal to 0.92 and 0.91, respectively). BrP-FOPQ-A confirmatory factor analysis yielded a two-factor structure while the factorial analyses of BrP-FOPQ-P demonstrated that the best solution was a three-structure factorial. The BrP-FOPQ-P scores in healthy adolescents and those in chronic pain conditions was 34.13 (16.71) vs 43.14 (18.08), respectively. A generalized mixed model demonstrated that the scores in the BrP-FOPQ-A are higher in those with chronic pain conditions compared to healthy subjects (29.20 [12.77] vs 33.80 [10.76], respectively; Wald χ2= 17.80; df=1, P<0.0001). The model revealed that the BDNF was positively correlated with the score of BrP-FOPQ-A and subjects with chronic pain showed higher levels of BDNF. Conclusion: The BrP-FOPQ scores for adolescents and parents were found to be psychometrically robust and reliable instruments, with primary evidence of validity. Higher scores on the BrP-FOPQ-A were correlated positively with saliva BDNF and permitted the identification of subjects with chronic pain conditions

Efecto de la hipnosis combinada con estimulación transcraniana de corriente continua en la percepción del dolor y en la función del sistema descendente en sujetos sanos : ensayo clínico randomizado ciego cruzado controlado con uso simulado

Introducción: El dolor es un problema de salud pública, asociado al sufrimiento y la incapacidad funcional. Sus consecuencias permanecen en la vida personal y social del paciente, llevando a cambios significativos en sus relaciones interpersonales, laborales, familiar y social, disminuyendo la capacidad para realizar las actividades diarias. Las técnicas farmacológicas tienes resultados parciales en los pacientes, muchos de ellos acaban por convertirse en pacientes polimedicados y refractarios al tratamiento. Las técnicas no farmacológicas son promisorias y tienen evidencia científica positivas en el efecto del dolor, teniendo mayores estudios en los últimos años con técnicas como electroacupuntura. estimulación magnética transcraneana, estimulación transcraneana de corriente continua, terapia cognitiva conductual y hipnosis. Entre las que se destacan es la estimulación transcraniana de corriente continua (ETCC) y la sugestion a la analgesia hipnótica. Considerando las limitaciones de las opciones farmacológicas en el tratamiento de dolores crónicos, nuevas investigaciones deben orientarse a propiciar el avance en el proceso y comprensión de los mecanismos del dolor y proporcionar nuevas posibilidades terapéuticas con el potencial de modificar los procesos de neuroplasticidad disfuncional asociados al dolor crónico. Objetivo: Los objetivos fueron dos: (I) Determinar si la sugerencia de analgesia hipnótica y la estimulación transcraniana de corriente continua (ETCC) tienen un efecto diferencial en la percepción del dolor. Planteamos la hipótesis de que la estimulación transcraniana de corriente continua sería más efectiva que la analgesia hipnótica para cambiar el sistema de modulación del dolor descendente, mientras que la sugestión hipnótica tendría un mayor efecto en las pruebas sensoriales cuantitativas. (ii) Pretende comprender el efecto combinado de la estimulación de corriente continua transcraneal (a-ETCC) y la sugerencia de analgesia hipnótica sobre la percepción del dolor y el sistema de modulación del dolor descendente (SMDD). Esta investigación también pretende determinar si el efecto de a-ETCC y la sugerencia de analgesia hipnótica en las medidas psicofísicas (CPM-task, HPT, HPTo y CPT) podría asociarse con el nivel sérico de BDNF. Planteamos la hipótesis de que la terapia combinada (a-ETCC / sugerencia hipnótica) presentaría más efectividad en la percepción del dolor y SMDD que las intervenciones individuales (a-ETCC o sugerencia hipnótica). Métodos: Se incluyeron mujeres sanas de 18 a 45 años, con una alta susceptibilidad a la hipnosis, según la Escala de susceptibilidad hipnótica de Waterloo-Stanford Group, Forma C . Los sujetos recibieron una estimulación de corriente continua transcraneal anodal (a-ETCC) sobre DLPFC izquierdo (2 mA durante 20 min) y analgesia hipnótica (20 min). En estudio I: Se incluyeron 24 mujeres aleatorizados y asignados en uno de los dos grupos de intervención con una distribución cruzada para uno del los grupos: (1) a-ETCC (2mA, 20min) e (2) Sugerencia hipnótica (20min). En estudio II: Se incluyeron 48 mujeres aleatorizados y asignados en uno de los cuatro grupos de intervención: (1) a-ETCC (2mA, 20min), (2) Sugerencia hipnótica (20min), (3) a-ETCC / Sugerencia hipnótica (2mA, 20min) o (4) s-ETCC / Sugerencia hipnótica (0mA, 20min). Después de la primera intervención, los participantes regresaron para una segunda sesión experimental para recibir una intervención alternativa. El grupo 1 pasó a recibir la intervención del grupo 2 y viceversa. Lo mismo se aplicó entre el grupo 3 y 4. Resultados: Los resultados del estudio I revelaron que solo la sugerencia hipnótica produjo cambios que son estadísticamente significativos desde antes de la intervención hasta después de la intervención en las siguientes medidas: umbral de dolor por calor, tolerancia al dolor por calor, prueba de presión en frío y factor Neurotrófico derivado del cerebro en suero. El análisis mostró un efecto principal significativo para el tratamiento (F = 4.32; P = 0.04) cuando comparamos la tarea delta- (Δ) de la modulación condicionada del dolor entre los grupos de estimulación transcraniana de corriente continua y de sugerencia hipnótica. Además, el cambio en el factor Neurotrófico derivado del cerebro se correlacionó positivamente con la tarea de modulación del dolor condicionada. Los resultados de estudio II demostraron que la sugerencia de hipnosis sola o combinada para a- o s-ETCC ha demostrado reducir la eficiencia del sistema de modulación del dolor descendente cuando se compara con a-ETCC solamente. El uso de a-ETCC mejoró el SMDD en un 53,70% en comparación con a-ETCC / Sugerencia hipnótica. La sugerencia hipnótica combinada con a-ETCC o s-ETCC aumentó el HPTo cuando se comparó con a-ETCC solo. Mientras que en s-ETCC / Sugerencia hipnótica aumentó HPTo casi 16 veces. La combinación de a-ETCC y la sugerencia hipnótica aumentó el CPT casi seis veces en comparación con a-ETCC solo y en un 156% en comparación con la sugerencia hipnótica solamente. Además, los niveles más altos de BDNF en la línea de base se correlacionaron positivamente con un cambio mayor en el valor de CPTo en el a-ETCC y en el CPT con a-ETCC / Sugerencia hipnótica. Conclusiones: Los resultados confirman un efecto diferencial entre la sugerencia hipnótica y la estimulación de corriente directa transcraneal en las medidas del dolor. Sugieren que el impacto de las intervenciones tiene mecanismos neurales diferenciales, ya que la sugerencia hipnótica mejoró la percepción del dolor, mientras que la estimulación transcraniana de corriente continua aumentó la inhibición del sistema de modulación del dolor descendente. Mientras que el efecto combinado no mejoró la eficiencia de la inhibición en el SMDD.Pain is a public health problem, associated with suffering and functional disability. Its consequences remain in the personal and social life of the patient, leading to significant changes in their interpersonal, work, family and social relationships, decreasing the ability to perform daily activities. Pharmacological techniques present a poor therapeutic response in most patients, many of them end up becoming polymedicated and refractory to treatment. The nonpharmacological techniques are promising and have positive scientific evidence of its effects on pain, with an increase in the number of studies with neuromodulatory techniques such as acupuncture, electroacupuncture, TMS, tDCS and hypnosis. Among those that stand out most are the transcranial direct current stimulation (ETCC) and the hypnotic analgesia suggestion. Considering the limitations of pharmacological options in the treatment of chronic pain, new research should be oriented to promote progress in the process and understanding of the mechanism of pain, providing new therapeutic possibilities with the potential to modify the dysfunctional neuroplasticity processes associated with chronic pain, aiming at clinical improvement. Objectives: There were two objectives: (I) To determine whether the suggestion of hypnotic analgesia and the transcranial direct current stimulation (tDCS) have a differential effect on the perception of pain. We hypothesized that transcranial direct current stimulation would be more effective than hypnotic analgesia in changing the descending pain modulating system (DPMS), whereas hypnotic suggestion would have a greater effect on quantitative sensory tests. (ii) Understand the combined effect of transcranial direct current stimulation (a tDCS) and the hypnotic analgesia suggestion on pain perception and the descending pain modulating system. This research also aims to determine if the effect of a-tDCS and the suggestion of hypnotic analgesia in psychophysical measures (CPM-task, HPT, HPTo and CPT) could be associated with the serum level of BDNF. We hypothesized that the combined therapy (a-tDCS / hypnotic analgesia suggestion) would be more effective in pain perception and DPMS than individual interventions (a-tDCS or hypnotic analgesic suggestion). Methods: Healthy women aged 18 to 45 years were included, with a high susceptibility to hypnosis, according to the Waterloo-Stanford Group hypnotic susceptibility scale, Form C. Subjects received an anodal transcranial direct current stimulation (a-tDCS) on left DLPFC (2 mA for 20 min) and hypnotic analgesia (20 min). In study I: 24 randomized and assigned women were included in one of the two intervention groups with a cross-sectional distribution for one of the groups: (1) a-tDCS (2mA, 20min) or (2) Hypnotic suggestion (20min). In study II: 48 randomized and assigned women were included in one of the four intervention groups: (1) atDCS (2mA, 20min), (2) Hypnotic analgesia suggestion (20min), (3) a-tDCS / Hypnotic analgesia suggestion (2mA, 20min) or (4) s-tDCS / Hypnotic analgesia suggestion (0mA, 20min). After the first intervention, the participants returned for a second experimental session to receive an alternative intervention. Group 1 went on to receive group 2 intervention and vice versa. The same was applied between group 3 and 4. Results: The results of the study I revealed that only the hypnotic suggestion produced changes that are statistically significant from pre to pos intervention in the following measures: heat pain threshold, heat pain tolerance, cold pressure test and neurotrophic factor derived from the brain in serum. The analysis showed a significant main effect for the treatment (F = 4.32, P = 0.04) when we compared the delta (Δ) task of the conditioned pain modulation between the groups of transcranial direct current stimulation and hypnotic suggestion. In addition, the change in the neurotrophic factor derived from the brain correlated positively with the task of conditioned pain modulation. The results of study II demonstrated that hypnotic suggestion alone or combined with a- or s-tDCS has been shown to reduce the efficiency of the descending pain modulation system when compared to a-tDCS alone. The use of a-tDCS improved the DPMS by 53.70% compared to a-tDCS / Hypnotic suggestion. The hypnotic suggestion combined with a-TDCS or s-TDCS increased the HPTo when compared with a-TDCS alone. While in s-tDCS / Hypnotic suggestion HPTo increased almost 16 times. The combination of a-tDCS and the hypnotic suggestion increased the CPT by almost six times compared to a-tDCS alone and by 156% compared to the hypnotic suggestion alone. In addition, the highest levels of BDNF in the baseline correlated positively with a greater change in the CPTo value in the a-tDCS and in the CPT with a-tDCS / Hypnotic suggestion. Conclusions: The results confirm a differential effect between hypnotic suggestion and transcranial direct current stimulation in pain measurements. They suggest that the impact of the interventions has differential neural mechanisms, since the hypnotic suggestion improved the perception of pain, whereas the stimulation by transcranial direct current increased the inhibition of the descending pain modulating system. While the combined effect did not improve the efficiency of inhibition in the DPMS