Transcranial direct current electrical stimulation in combination with aerobic exercise: A pilot study in post-COVID-19 systemic autoimmune rheumatic patients

BACKGROUND Systemic autoimmune rheumatic diseases（SARDs） are a group of diseases with multiorgan involvement and a high prevalence of chronic pain and fatigue. Patients with SARDs and post-coronavirus disease 2019（COVID-19） syndrome experience aggravation of symptoms. In this context, it is essential to establish strategies to reduce chronic pain and fatigue and improve quality of life.AIM To assess the efficacy of transcranial direct current stimulation（tDCS） for the treatment of fatigue and pain-associated post-COVID-19 syndrome in patients with SARDs.METHODS This study included nine patients with different types of SARDs. All patients had reverse transcription-polymerase chain reaction（RT-PCR） test confirmed COVID-19 as well as significant, persistent fatigue and pain that began to worsen after infection. Anodal tDCS was administered in five daily sessions（2mA, 20 min）. Concomitantly, patients were involved in aerobic exercise program. All participants were evaluated using specific questionnaires and strength assessment by handgrip and physical function by timed-up-and-go test and sit-to-stand test at baseline（within one week before tDCS protocol）, and one week after tDCS protocol. During all procedures, the patients’ treatments remained unchanged.RESULTS The sample comprised eight women and one man with a mean age of 48.7 ± 9.6 years. After the tDCS protocol, pain and fatigue significantly improved on the visual analog scale（P ＜ 0.05）. The physical function also improved 9.5 ± 2.7 vs 6.8 ± 0.8（P = 0.001） for timed-up-go-test and 10.3 ± 3.7 vs 15.1 ± 4.0（P = 0.037） for sit-to-stand test. None of the patients experienced any adverse events.CONCLUSION The present study showed that tDCS in combination with aerobic exercise was effective in improving physical function, and reducing fatigue/pain in SARDs patients with post-COVID-19 syndrome.