Year 2023 / Volume 30 / Number 1

Abstract PDF HTML

EJP article

Effects of transcranial direct current stimulation in pain and opioid consumption after spine surgery

Rev. Soc. Esp. Dolor. 2023; 30(1): 49-59 / DOI: 10.1002/ejp.1985

Rasha Hamed, Eman M. Khedr, Nourelhoda A. Haridy, Khaled O. Mohamed, Saeid Elsawy


ABSTRACT

Background: Transcranial direct current stimulation (tDCS) has shown promising results in alleviating different types of pain. The present study compares the efficacy of three sessions of anodal tDCS applied over primary motor area (M1) or the left dorsolateral prefrontal cortex (DLPFC) or sham on reducing pain and the total opioid consumption in postoperative spine surgery patients.
Materials: Sixty-seven out of 75 eligible patients for postoperative spine surgery were randomly allocated into one of the three experimental groups. Group A received anodal tDCS applied over M1 cortex, group B over left DLPF cortex (2 mA, 20 min) and group C received sham tDCS, all for 3 consecutive postoperative days. Patients were evaluated using a visual analogue scale (VAS) and adynamic visual analogue scale (DVAS) at baseline, and on each of the treatment days. The total morphine consumption over the 3 postoperative days was assessed.
Results: Two-way repeated measures ANOVA showed no statistically significant difference in resting VAS between the three groups. However, there was significant pain improvement (P < 0.001) in DVAS in both active groups (group A and B) compared to the sham group (group C) in the postoperative period, with no significant difference between the active groups. Morphine consumption was significantly reduced in both active groups compared with the sham group,but there was no difference in consumption between the active groups.
Conclusion: There was a significant postoperative reduction in morphine consumption and DVAS scores after three sessions of active tDCS.
Significance: tDCS is a promising tool for alleviating pain in the field of postoperative spine surgery.



RESUMEN

Antecedentes: La estimulación transcraneal por corriente continua (ETCC o tDCS, por sus siglas en inglés) ha obtenido resultados prometedores para aliviar distintos tipos de dolor. El presente estudio compara la eficacia de tres sesiones de ETCC anódica aplicada sobre el área motora primaria (M1) o la corteza prefrontal dorsolateral (CPFDL) izquierda, o simulada, para reducir el dolor y el consumo total de opioides en pacientes en el postoperatorio de una cirugía de columna vertebral.
Materiales: Sesenta y siete de 75 pacientes elegibles en el postoperatorio de una cirugía raquídea fueron asignados a uno de tres grupos experimentales. El grupo A recibió ETCC anódica sobre la corteza M1, el grupo B la recibió sobre la CPFDL izquierda (2 mA, 20 min) y el grupo C recibió una ETCC simulada, todos durante 3 días consecutivos del postoperatorio. Los pacientes se evaluaron mediante una escala analógica visual (EAV) y una escala analógica visual dinámica (EAVD) basalmente y en cada uno de los días de tratamiento. Se evaluó el consumo total de morfina durante los 3 días del postoperatorio.
Resultados: El ANOVA de dos vías de medidas repetidas no mostró ninguna diferencia significativa en la EAV de reposo entre los tres grupos. Sin embargo, hubo una mejoría significativa del dolor (P < 0,001) en la EAVD en ambos grupos activos (grupos A y B) frente al grupo con simulación (grupo C) en el postoperatorio, sin diferencias significativas entre los grupos activos. El consumo de morfina se redujo significativamente en ambos grupos activos frente al grupo simulado, pero no hubo diferencias de consumo entre los grupos activos. Conclusión: Hubo una reducción significativa del consumo de morfina y de las puntuaciones de la EAVD en el postoperatorio después de las tres sesiones de ETCC real.
Significación: La ETCC es una herramienta prometedora para aliviar el dolor en el campo de la cirugía raquídea durante el postoperatorio.





Complete Article

Nuevo comentario

Security code:
CAPTCHA code image
Speak the codeChange the code
 

Comentarios

No comments in this article

Bibliografía

1. Bajwa, S. J., & Haldar, R. (2015). Pain management following spi- nal surgeries: An appraisal of the available options. Journal of Craniovertebral Junction and Spine, 6(3), 105–110. https://doi. org/10.4103/0974-8237.161589
DOI: 10.4103/0974-8237.161589
2. Steyaert, A., Lenoir, C., Lavandhomme, P., & Mouraux, A. (2019). Transcranial direct current stimulation as a tool for postoper- ative pain management: a review of the current clinical evi- dence. Acta Anaesthesiologica Belgica, 70, 175–183.
3. Borckardt, J. J., Reeves, S. T., Milliken, C., Carter, B., Epperson, T. I., Gunselman, R. J., … George, M. S. (2017). Prefrontal versus motor cortex transcranial direct current stimulation (tDCS) effects on post-surgical opioid use. Brain Stimulation, 10(6), 1096–1101. https://doi.org/10.1016/j.brs.2017.09.006
DOI: 10.1016/j.brs.2017.09.006
4. Glaser, J., Reeves, S. T., Stoll, W. D., Epperson, T. I., Hilbert, M., Madan, A., … Borckardt, J. J. (2016). Motor/prefrontal transcra- nial direct current stimulation (tDCS) following lumbar sur- gery reduces postoperative analgesia use. Spine, 41(10), 835– 839. https://doi.org/10.1097/BRS.0000000000001525
DOI: 10.1097/BRS.0000000000001525
5. Jiang, N., Li, G., Wei, J., Wei, B., Zhu, F. F., & Hu, Y. (2018). Transcranial direct current stimulation of the primary motor cortex on postoperative pain and spontaneous oscillatory elec- troencephalographic activity following lumbar spine surgery: A pilot study. Restorative Neurology and Neuroscience, 36(5), 605– 620. https://doi.org/10.3233/RNN-180816
DOI: 10.3233/RNN-180816
6. Khedr, E. M., Sharkawy, E. S. A., Attia, A. M. A., Ibrahim Osman, N. M., & Sayed, Z. M. (2017). Role of transcranial direct current stimulation on reduction of postsurgical opioid consumption and pain in total knee arthroplasty: Double randomized clinical trial. European Journal of Pain (United Kingdom), 21(8), 1355– 1365. https://doi.org/10.1002/ejp.1034
DOI: 10.1002/ejp.1034
7. Ribeiro, H., Sesterhenn, R. B., De Souza, A., De Souza, A. C., Alves, M., Machado, J. C., … Caumo, W. (2017). Preoperative transcra- nial direct current stimulation: Exploration of a novel strategy to enhance neuroplasticity before surgery to control postoper- ative pain. A randomized sham-controlled study. PLoS ONE, 12(11), 1–17. https://doi.org/10.1371/journal.pone.0187013
DOI: 10.1371/journal.pone.0187013
8. Li, X., Yao, J., Zhang, W., Chen, S., & Peng, W. (2021). Effects of transcranial direct current stimulation on experimental pain perception: A systematic review and meta-analysis. Clinical Neurophysiology, 132(9), 2163–2175. https://doi.org/10.1016/j. clinph.2021.05.020
9. Garcia-Larrea, L. G., Peyron, R., Mertens, P., Grégoire, M. C., Lavenne, F., Bonnefoi, F., … Sindou, M. (1997). Positron emis- sion tomography during motor cortex stimulation for pain con- trol. Stereotactic and Functional Neurosurgery, 68(1–4), 141– 148. https://doi.org/10.1159/000099915
DOI: 10.1159/000099915
10. García-Larrea, L., Peyron, R., Mertens, P., Gregoire, C. M., Lavenne, F., Le Bars, D., … Laurent, B. (1999). Electrical stimulation of motor cortex for pain control: a combined PET-scan and electrophysiological study. Pain, 83(2), 259–273. https://doi. org/10.1016/S0304-3959(99)00114-1
DOI: 10.1016/S0304-3959(99)00114-1
11. Peyron, R., Garcia-Larrea, L., Deiber, M. P., Cinotti, L., Convers, P., Sindou, M., … Laurent, B. (1995). Electrical stimulation of precentral corticalarea in the treatment of central pain: Electrophysiological and PET study. Pain, 62(3), 275–286. https://doi.org/10.1016/0304-3959(94)00211-V
DOI: 10.1016/0304-3959(94)00211-V
12. Lorenz, J., Minoshima, S., & Casey, K. L. (2003). Keeping pain out of mind: The role of the dorsolateral prefrontal cortex in pain modulation. Brain, 126(5), 1079–1091. https://doi.org/10.1093/ brain/awg102
DOI: 10.1093/brain/awg102
13. Seminowicz, D. A., & Moayedi, M. (2017). The dorsolateral prefron- tal cortex in acute and chronic pain. The Journal of Pain, 18(9), 1027–1035. https://doi.org/10.1016/j.jpain.2017.03.008
DOI: 10.1016/j.jpain.2017.03.008
14. Boggio, P. S., Zaghi, S., & Fregni, F. (2009). Modulation of emotions associated with images of human pain using anodal tran- scranial direct current stimulation (tDCS). Neuropsychologia, 47(1), 212–217. https://doi.org/10.1016/j.neuropsych ologia.2008.07.022
15. Borckardt, J. J., Glaser, J. A., Carver, K. C., Reeves, S. T., George, M. S., Fredrich, S., & Hohenberger, J. (2013). Transcranial direct current stimulation (tDCS) in the management of acute post- spine surgery pain: A prospective randomized controlled trial. The Spine Journal, 13(9), S119. https://doi.org/10.1016/j. spinee.2013.07.312
16. Dubois, P. E., Ossemann, M., De Fays, K., De Bue, P., Gourdin, M., Jamart, J., & Vandermeeren, Y. (2013). Postoperative analgesic effect of transcranial direct current stimulation in lumbar spine surgery: A randomized control trial. The Clinical Journal of Pain, 29, 696–701.
DOI: 10.1097/AJP.0b013e31826fb302
17. O'Connell, N. E., Marston, L., Spencer, S., DeSouza, L. H., & Wand, B. M. (2018). Non-invasive brain stimulation techniques for chronic pain. Cochrane Database of Systematic Reviews, 2018(8), CD008208. https://doi.org/10.1002/14651858.CD008208.pub5
DOI: 10.1002/14651858.CD008208.pub5
18. Nitsche, M. A., & Paulus, W. (2001). Sustained excitability elevations induced by transcranial DC motor cortex stimulation in hu- mans. Neurology, 57(10), 1899–1901. https://doi.org/10.1212/ WNL.57.10.1899
DOI: 10.1212/WNL.57.10.1899
19. Castillo-Saavedra, L., Gebodh, N., Bikson, M., Diaz-Cruz, C., Brandao, R., Coutinho, L., … Fregni, F. (2016). Clinically ef- fective treatment of fibromyalgia pain with high-definition transcranial direct current stimulation: Phase II open-label dose optimization. Journal of Pain, 17(1), 14–26. https://doi. org/10.1016/j.jpain.2015.09.009
DOI: 10.1016/j.jpain.2015.09.009
20. Stamenkovic, D. M., Mladenovic, K., Rancic, N., Cvijanovic, V., Maric, N., Neskovic, V., … Ilic, T. V. (2020). Effect of transcranial direct current stimulation combined with patient-controlled intravenous morphine analgesia on analgesic use and post- thoracotomy pain. A prospective, randomized, double-blind, sham-controlled, proof-of-concept clinical trial. Frontiers in Pharmacology, 11(February), 1–14. https://doi.org/10.3389/ fphar.2020.00125
21. Fregni, F., Gimenes, R., Valle, A. C., Ferreira, M. J. L., Rocha, R. R., Natalle, L., … Boggio, P. S. (2006). A randomized, sham- controlled, proof of principle study of transcranial direct cur- rent stimulation for the treatment of pain in fibromyalgia. Arthritis and Rheumatism, 54(12), 3988–3998. https://doi. org/10.1002/art.22195
DOI: 10.1002/art.22195
22. Kulandaivelan, S., Joshi, S., Chaturvedi, R., & Malik, M. (2018). Effect of transcranial direct current stimulation (TDCS) on pain in fibromyalgia-systematic review based on Prisma guide- lines. Journal of Physiology, 3(2), 858–862.
23. Lefaucheur, J. P., Antal, A., Ahdab, R., Ciampi de Andrade, D., Fregni, F., Khedr, E. M., … Paulus, W. (2008). The use of repetitive tran- scranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) to relieve pain. Brain Stimulation, 1(4), 337–344. https://doi.org/10.1016/j.brs.2008.07.003
DOI: 10.1016/j.brs.2008.07.003
24. Lloyd, D. M., Wittkopf, P. G., Arendsen, L. J., & Jones, A. K. P. (2020). Is transcranial direct current stimulation (tDCS) effective for the treatment of pain in fibromyalgia? A systematic review and meta-analysis. Journal of Pain, 21(11–12), 1085–1100. https:// doi.org/10.1016/j.jpain.2020.01.003
DOI: 10.1016/j.jpain.2020.01.003
25. Pinto, C. B., Teixeira Costa, B., Duarte, D., & Fregni, F. (2018). Transcranial direct current stimulation as a therapeutic tool for chronic pain. The Journal of ECT, 34(3), e36–e50. https://doi. org/10.1097/YCT.0000000000000518
DOI: 10.1097/YCT.0000000000000518
26. Fregni, F., El-Hagrassy, M. M., Pacheco-Barrios, K., Carvalho, S., Leite, J., Simis, M., … Brunoni, A. R. (2021). Evidence-based guidelines and secondary meta-analysis for the use of transcra- nial direct current stimulation in neurological and psychiatric disorders. International Journal of Neuropsychopharmacology, 24(4), 256–313. https://doi.org/10.1093/ijnp/pyaa051
DOI: 10.1093/ijnp/pyaa051
27. Homan, R. W., Herman, J., & Purdy, P. (1987). Cerebral loca- tion of international 10–20 system electrode placement. Electroencephalography and Clinical Neurophysiology, 66(4), 376–382. https://doi.org/10.1016/0013-4694(87)90206-9
DOI: 10.1016/0013-4694(87)90206-9
28. Herwig, U., Satrapi, P., & Schönfeldt-Lecuona, C. (2003). Using the International 10-20 EEG system for positioning of transcranial magnetic stimulation. Brain Topography, 16(2), 95–99. https:// doi.org/10.1023/B:BRAT.0000006333.93597.9d
DOI: 10.1023/B:BRAT.0000006333.93597.9d
29. Fregni, F., Boggio, P. S., Lima, M. C., Ferreira, M. J. L., Wagner, T., Rigonatti, S. P., … Pascual-Leone, A. (2006). A sham- controlled, phase II trial of transcranial direct current stim- ulation for the treatment of central pain in traumatic spinal cord injury. Pain, 122(1), 197–209. https://doi.org/10.1016/j. pain.2006.02.023
30. Khedr, E. M., El Gamal, N. F., El-Fetoh, N. A., Khalifa, H., Ahmed, E. M., Ali, A. M., … Karim, A. A. (2014). A double-blind ran- domized clinical trial on the efficacy of cortical direct current stimulation for the treatment of Alzheimer's disease. Frontiers in Aging Neuroscience, 6, 1–12. https://doi.org/10.3389/ fnagi.2014.00275
DOI: 10.3389/fnagi.2014.00275
31. Khedr, E. M., Elfetoh, N. A., Ali, A. M., & Noamany, M. (2014). Anodal transcranial direct current stimulation over the dor- solateral prefrontal cortex improves anorexia nervosa: A pilot study. Restorative Neurology and Neuroscience, 32(6), 789–797. https://doi.org/10.3233/RNN-140392
DOI: 10.3233/RNN-140392
32. DaSilva, A. F., Volz, M. S., Bikson, M., & Fregni, F. (2011). Electrode positioning and montage in transcranial direct current stimu- lation. Journal of Visualized Experiments, 51, 1–11. https://doi. org/10.3791/2744
33. De Icco, R., Putortì, A., De Paoli, I., Ferrara, E., Cremascoli, R., Terzaghi, M., … Tassorelli, C. (2021). Anodal transcranial di- rect current stimulation in chronic migraine and medication overuse headache: A pilot double-blind randomized sham- controlled trial. Clinical Neurophysiology, 132(1), 126–136. https://doi.org/10.1016/j.clinph.2020.10.014
DOI: 10.1016/j.clinph.2020.10.014
34. Pacheco-Barrios, K., Cardenas-Rojas, A., Thibaut, A., Costa, B., Ferreira, I., Caumo, W., & Fregni, F. (2020). Methods and strat- egies of tDCS for the treatment of pain: current status and fu- ture directions. Expert Review of Medical Devices, 17, 879–898. https://doi.org/10.1080/17434440.2020.1816168
DOI: 10.1080/17434440.2020.1816168
35. Borckardt, J. J., Romagnuolo, J., Reeves, S. T., Madan, A., Frohman, H., Beam, W., & George, M. S. (2011). Feasibility, safety, and effectiveness of transcranial direct current stimulation for de- creasing post-ERCP pain: A randomized, sham-controlled, pilot study. Gastrointestinal Endoscopy, 73(6), 1158–1164. https:// doi.org/10.1016/j.gie.2011.01.050
DOI: 10.1016/j.gie.2011.01.050
36. Khedr, E. M., Omran, E. A. H., Ismail, N. M., El-Hammady, D. H., Goma, S. H., Kotb, H., … Ahmed, G. A. (2017). Effects of tran- scranial direct current stimulation on pain, mood and serum endorphin level in the treatment of fibromyalgia: A double blinded, randomized clinical trial. Brain Stimulation, 10(5), 893–901. https://doi.org/10.1016/j.brs.2017.06.006
DOI: 10.1016/j.brs.2017.06.006
37. DosSantos, M. F., Love, T. M., Martikainen, I. K., Nascimento, T. D., Fregni, F., Cummiford, C., … DaSilva, A. F. M. (2012). Immediate effects of tDCS on the µ-opioid system of a chronic pain pa- tient. Frontiers in Psychiatry, 3, 1–6. https://doi.org/10.3389/ fpsyt.2012.00093
38. Boggio, P. S., Zaghi, S., Lopes, M., & Fregni, F. (2008). Modulatory effects of anodal transcranial direct current stimulation on perception and pain thresholds in healthy volunteers. European Journal of Neurology, 15(10), 1124–1130. https://doi. org/10.1111/j.1468-1331.2008.02270.x
DOI: 10.1111/j.1468-1331.2008.02270.x
39. Mylius, V., Jung, M., Menzler, K., Haag, A., Khader, P. H., Oertel, W. H., … Lefaucheur, J. P. (2012). Effects of transcranial direct current stimulation on pain perception and working mem- ory. European Journal of Pain, 16(7), 974–982. https://doi. org/10.1002/j.1532-2149.2011.00105.x
DOI: 10.1002/j.1532-2149.2011.00105.x
40. Accornero, N., Li Voti, P., La Riccia, M., & Gregori, B. (2007). Visual evoked potentials modulation during direct current cortical polarization. Experimental Brain Research, 178(2), 261–266. https://doi.org/10.1007/s00221-006-0733-y
DOI: 10.1007/s00221-006-0733-y
41. Vandermeeren, Y., Jamart, J., & Ossemann, M. (2010). Effect of tDCS with an extracephalic reference electrode on cardio-respiratory and autonomic functions. BMC Neuroscience, 11, 2014. https:// doi.org/10.1186/1471-2202-11-38
DOI: 10.1186/1471-2202-11-38
42. Marret, E., Kurdi, O., Zufferey, P., & Bonnet, F. (2005). Effects of nonsteroidal antiinflammatory drugs on patient-controlled analgesia morphine side effects: Meta-analysis of randomized controlled trials. Anesthesiology, 102(6), 1249–1260. https://doi. org/10.1097/00000542-200506000-00027
DOI: 10.1097/00000542-200506000-00027
43. Kold, S., & Graven-Nielsen, T. (2021). Effect of anodal high-definition transcranial direct current stimulation on the pain sensitivity in a healthy population: a double-blind, sham-controlled study. Pain, 162(6), 1659–1668. https://doi.org/10.1097/j.pain.0000000000002187
DOI: 10.1097/j.pain.0000000000002187

Artículos relacionados

Instrucciones para citar

Hamed R, Khedr E, Haridy N, Mohamed K, Elsawy S. Effects of transcranial direct current stimulation in pain and opioid consumption after spine surgery. Rev Soc Esp Dolor 2023; 30(1): 49-59 / DOI: 101002/ejp1985


Descargar a un gestores de citas

Descargue la cita de este artículo haciendo clic en uno de los siguientes gestores de citas:

Métrica

Este artículo ha sido visitado 7848 veces.
Este artículo ha sido descargado 2 veces.

Estadísticas de Dimensions


Estadísticas de Plum Analytics

Ficha Técnica

Aceptado: 09/05/2023

Publicado: 23/05/2023


Compartir

Este artículo aun no tiene valoraciones.
Reader rating:
Rate this article:
Send by e-mail
© 2024 Revista de la Sociedad Española del Dolor
ISSN: 1134-8046   e-ISSN: 2254-6189

       Indexada en:
Política de Privacidad