1
|
Lyra de Brito Aranha RE, Nascimento JDSD, Sampaio DDA, Torro-Alves N. Combining Transcranial Direct Current Stimulation With Non-Invasive Interventions for Chronic Primary Pain: A Systematic Review and Meta-Analysis. Neurorehabil Neural Repair 2024; 38:616-632. [PMID: 39075920 DOI: 10.1177/15459683241265906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
BACKGROUND A growing number of studies has combined transcranial direct current stimulation (tDCS) with other non-invasive non-pharmacological therapies (NINPT) to enhance effects in pain reduction. However, the efficacy of these combined approaches in treating chronic primary pain (CPP) warrants thorough investigation. OBJECTIVE This study aims to evaluate the efficacy of tDCS in conjunction with other NINPT in alleviating pain severity among CPP patients. METHODS We conducted a systematic search for randomized controlled trials (RCTs) comparing the efficacy of tDCS combined with NINPT against control treatments in adult CPP patients. The search spanned multiple databases, including PubMed, EMBASE, LILACS, Scopus, Web of Science, and CENTRAL. RESULTS Our systematic review included 11 RCTs with a total of 449 participants. In our meta-analysis, which comprised 228 participants receiving active-tDCS and 221 receiving sham-tDCS, we found a significant reduction in pain intensity (Standard Mean Difference = -0.73; 95% Confidence Interval (CI) = -1.18 to -0.27; P = .002) with the use of active-tDCS combined with NINPT. CONCLUSION These findings substantiate the therapeutic potential of combining tDCS with other NINPT, highlighting it as an effective treatment modality for reducing pain intensity in CPP patients.
Collapse
Affiliation(s)
| | | | | | - Nelson Torro-Alves
- Cognitive Neuroscience and Behavior Program, Federal University of Paraíba, João Pessoa, Brazil
| |
Collapse
|
2
|
Lozano-Meca J, Montilla-Herrador J, Gacto-Sánchez M. The effects of combined transcranial direct Current stimulation with physiotherapy for physical function in subjects with knee osteoarthritis: a systematic review and meta-analysis. Physiother Theory Pract 2024:1-17. [PMID: 38818760 DOI: 10.1080/09593985.2024.2360570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Transcranial Direct Current Stimulation (tDCS) emerges as a promising therapeutic intervention for knee osteoarthritis (KOA), yet its impact on physical function remains insufficiently explored. OBJECTIVES To evaluate the relative effects of tDCS for physical function in patients with KOA. METHODS Pubmed, Web of Science, Scopus and Cochrane Database were explored as of August 2023 to identify studies to be included in the current systematic review and metaanalysis. Randomized controlled trials in patients with KOA comparing tDCS with placebo were included. The outcomes defined were measures of physical function (questionnaires, gait, or physical performance). The Risk of Bias tool was used to assess bias in the randomized controlled trials, whereas the PEDro scale was applied for methodological quality, and the certainty of evidence for each outcome was assessed through GRADE. Results for each outcome were synthesized using meta-analysis (random-effects model, I2-test for heterogeneity) and a subgroup analysis was performed to improve the sensitivity of the results and to explore potential moderating factors of the effect sizes. RESULTS Ten studies with good to excellent quality were included, analyzing a total of 628 participants. Regarding physical function, tDCS showed a favorable effect (ES: -0.58; 95%CI -0.82, -0.33; I2: 52.1%) with a low risk of bias and low to moderate certainty of evidence. The concurrent application of physiotherapy interventions and tDCS improved the effects on pain and function. Applying physiotherapy interventions, as well as adding peripheral currents, increased the effect sizes (ES: -0.95, k = 3, p = .018; ES: -0.95, k = 4 p = .001, respectively). The pattern of application of the tDCS, either daily or in alternate days, did not moderate the effect size (p = .619). Meta-regression revealed that the number of tDCS sessions did not moderate the effect size either (p = .242). CONCLUSION The tDCS might be a promising therapeutic approach to enhance physical function in subjects affected with KOA. However, further systematic reviews with meta-analyses should be performed with standardized and proven-efficacy physiotherapy programs, as well as with long-term results, to ascertain whether the improvement may be sustained over time. This study provides valuable insights into optimizing tDCS interventions for enhanced outcomes in the management of KOA.Protocol available via PROSPERO [CRD42023440676].
Collapse
Affiliation(s)
- José Lozano-Meca
- Department of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain
| | - Joaquina Montilla-Herrador
- Department of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain
| | - Mariano Gacto-Sánchez
- Department of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain
| |
Collapse
|
3
|
Aljeradat B, Kumar D, Abdulmuizz S, Kundu M, Almealawy YF, Batarseh DR, Atallah O, Ennabe M, Alsarafandi M, Alan A, Weinand M. Neuromodulation and the Gut-Brain Axis: Therapeutic Mechanisms and Implications for Gastrointestinal and Neurological Disorders. PATHOPHYSIOLOGY 2024; 31:244-268. [PMID: 38804299 PMCID: PMC11130832 DOI: 10.3390/pathophysiology31020019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024] Open
Abstract
The gut-brain axis (GBA) represents a complex, bidirectional communication network that intricately connects the gastrointestinal tract with the central nervous system (CNS). Understanding and intervening in this axis opens a pathway for therapeutic advancements for neurological and gastrointestinal diseases where the GBA has been proposed to play a role in the pathophysiology. In light of this, the current review assesses the effectiveness of neuromodulation techniques in treating neurological and gastrointestinal disorders by modulating the GBA, involving key elements such as gut microbiota, neurotrophic factors, and proinflammatory cytokines. Through a comprehensive literature review encompassing PubMed, Google Scholar, Web of Science, and the Cochrane Library, this research highlights the role played by the GBA in neurological and gastrointestinal diseases, in addition to the impact of neuromodulation on the management of these conditions which include both gastrointestinal (irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and gastroesophageal reflux disease (GERD)) and neurological disorders (Parkinson's disease (PD), Alzheimer's disease (AD), autism spectrum disorder (ASD), and neuropsychiatric disorders). Despite existing challenges, the ability of neuromodulation to adjust disrupted neural pathways, alleviate pain, and mitigate inflammation is significant in improving the quality of life for patients, thereby offering exciting prospects for future advancements in patient care.
Collapse
Affiliation(s)
- Baha’ Aljeradat
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Danisha Kumar
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- Dow Medical College, Dow University of Health Sciences, Karachi 74200, Pakistan
| | - Sulaiman Abdulmuizz
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- College of Health Sciences, University of Ilorin, Ilorin 240003, Kwara, Nigeria
| | - Mrinmoy Kundu
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- Institute of Medical Sciences and SUM Hospital, Bhubaneswar 751029, India
| | - Yasser F. Almealawy
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- Faculty of Medicine, University of Kufa, Kufa P.O. Box 21, Iraq
| | - Dima Ratib Batarseh
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Oday Atallah
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- Department of Neurosurgery, Hannover Medical School, 30625 Hannover, Germany
| | - Michelle Ennabe
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- College of Medicine, The University of Arizona College of Medicine, Phoenix, AZ 85004, USA
| | - Muath Alsarafandi
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- College of Medicine, Islamic University of Gaza, Rafa Refugee Camp, Rafa P.O. Box 108, Palestine
- Faculty of Medicine, Islamic University of Gaza, Gaza P.O. Box 108, Palestine
| | - Albert Alan
- Global Neurosurgical Alliance, Tucson, AZ 85716, USA; (B.A.); (D.K.); (S.A.); (M.K.); (Y.F.A.); (D.R.B.); (O.A.); (M.E.); (M.A.)
- Department of Neurosurgery, University of Arizona, Tucson, AZ 85724, USA;
- College of Medicine, The University of Arizona College of Medicine, Tucson, AZ 85004, USA
| | - Martin Weinand
- Department of Neurosurgery, University of Arizona, Tucson, AZ 85724, USA;
- College of Medicine, The University of Arizona College of Medicine, Tucson, AZ 85004, USA
| |
Collapse
|
4
|
Yang JM, Li CC, Wang Y, Li JY, Xu JM, Liang MG, Ou L, Shen Z, Chen ZH. Transcranial Direct Current Stimulation for Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Arthritis Care Res (Hoboken) 2024; 76:376-384. [PMID: 37779486 DOI: 10.1002/acr.25249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/15/2022] [Accepted: 09/23/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE The effects of transcranial direct current stimulation (tDCS) in the treatment of knee osteoarthritis (KOA) is still unclear. The objective is to evaluate the efficacy and safety of tDCS in improving symptoms in patients with KOA. METHODS The following electronic databases were searched for eligible randomized controlled trials (RCTs): PubMed, Embase, Web of Science, and the Cochrane Library. The search was performed from the inception dates to April 30, 2023. Data extraction and quality assessment were performed by two independent reviewers. Standard mean differences (SMDs) with 95% confidence intervals (95% CIs) for pooled data were calculated. A random-effects model was used for the data analyses. The primary outcomes were pain and physical function. Secondary outcomes included stiffness, mobility performance, quality of life, pressure pain tolerance, and plasma levels of brain-derived neurotrophic factor (BDNF). RESULTS This meta-analysis included 13 RCTs. tDCS was significantly associated with pain decrease compared with sham tDCS (SMD = -0.62, 95% CI -0.87 to -0.37, P < 0.00001). When comparing tDCS plus other non-tDCS with sham tDCS plus other non-tDCS, there was no longer a significant association with pain decrease (SMD = -0.45, 95% CI -1.08 to 0.17, P = 0.16). The changes in physical function were not significantly different between the tDCS and sham tDCS groups (SMD = -0.09, 95% CI -0.56 to 0.38, P = 0.71). When comparing tDCS plus other non-tDCS with sham tDCS plus other non-tDCS, there was still no significant association with improvement in physical function (SMD = -0.66, 95% CI -1.63 to 0.30, P = 0.18). There was no significant difference with improvement in stiffness (SMD = -0.21, 95% CI -0.77 to 0.34, P = 0.45), mobility performance (SMD = 4.58, 95% CI -9.21 to 18.37, P = 0.51), quality of life (SMD = -7.01, 95% CI -22.61 to 8.59, P = 0.38), and pressure pain tolerance (SMD = 0.30, 95% CI -0.09 to 0.69, P = 0.13). There was a statistically significant reduction in plasma levels of BDNF (SMD = -13.57, 95% CI -24.23 to -2.92, P = 0.01). CONCLUSION In conclusion, tDCS could significantly alleviate pain, but it might have no efficacy in physical function, stiffness, mobility performance, quality of life, and pressure pain tolerance among patients with KOA.
Collapse
Affiliation(s)
- Jia-Man Yang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Cong-Cong Li
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yi Wang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jun-Yi Li
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jian-Mei Xu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | | | - Liang Ou
- Hunan Academy of Chinese Medcine, Changsha, China
| | - Zhen Shen
- Kunming Municipal Hospital of Traditional Chinese Medicine, The Third Affiliated Hospital of Yunnan University of Chinese Medicine, Kunming, China
| | - Ze-Hua Chen
- The Orthopedics Hospital of Traditional Chinese Medicine Zhuzhou City, Zhuzhou, China
| |
Collapse
|
5
|
Tedeschi R, Berti L, Platano D. "Transcranial Direct Current Stimulation (tDCS) in managing pain and recovery: A clinical case of radial capitellum fracture". Int J Surg Case Rep 2024; 114:109120. [PMID: 38061089 PMCID: PMC10755055 DOI: 10.1016/j.ijscr.2023.109120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 11/27/2023] [Accepted: 12/02/2023] [Indexed: 01/01/2024] Open
Abstract
INTRODUCTION The management of pain and functional recovery following a radial capitellum fracture poses a significant clinical challenge, especially in individuals whose professions, such as physiotherapy, demand optimal joint functionality. Transcranial Direct Current Stimulation (tDCS) emerges as a potential non-pharmacological intervention for pain management, necessitating exploration in the context of orthopedic injuries. CASE PRESENTATION A 41-year-old male physiotherapist presented with a MASON 2 radial capitellum fracture following a fall, experiencing notable pain (NPRS 6/7) and functional impairment (DASH 45/100, PRTEE 43/100). Conservative management, involving immobilization and potential surgical consideration, was employed, followed by tDCS for pain management. Post-tDCS, significant improvements were observed in pain and functional scores (NPRS to 0, DASH to 14.2, PRTEE to 7), alongside enhancements in range of motion and muscle strength. CLINICAL DISCUSSION The application of tDCS showcased notable efficacy in pain reduction and functional improvement, highlighting its potential in augmenting pain management strategies post-fracture. However, the variability in responses and lack of standardized application protocols necessitate further research to optimize its clinical utility. The balance between immobilization for fracture healing and mobilization for preventing stiffness and facilitating recovery was pivotal in managing the fracture and ensuring functional improvement. CONCLUSIONS This case underscores the potential of tDCS in managing pain and facilitating functional recovery in radial capitellum fractures, warranting further exploration and standardization of its application in clinical practice. The integrated, patient-centric approach, involving interdisciplinary collaboration and personalized care, was crucial in ensuring positive outcomes and provides a framework for managing similar orthopedic cases.
Collapse
Affiliation(s)
- Roberto Tedeschi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy (DIBINEM).
| | - Lisa Berti
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy (DIBINEM); Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Daniela Platano
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy (DIBINEM); Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| |
Collapse
|
6
|
Macri EM, Selles RW, Stefanik JJ, Reijman M. OARSI year in review 2023: Rehabilitation and outcomes. Osteoarthritis Cartilage 2023; 31:1534-1547. [PMID: 37673295 DOI: 10.1016/j.joca.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/16/2023] [Accepted: 08/31/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE We systematically reviewed the literature to identify comparative studies of core treatments (exercise, education, or weight management), adjunct treatments (e.g. electrotherapeutical modalities, bracing), or multimodal treatments (core plus other treatments), for treating osteoarthritis (OA) complaints, published between 1 March 2022 and 1 March 2023. DESIGN We searched three electronic databases for peer-reviewed comparative studies evaluating core treatments, adjunct treatments, or multimodal treatments for OA affecting any joint, in comparison to other OA treatments. Two authors independently screened records. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. A narrative synthesis focusing on pain and function outcomes was performed in studies with a mean sample size of at least 46 participants per treatment arm. RESULTS 33 publications (28 studies), 82% with PEDro ratings of good or excellent, were eligible for narrative synthesis: 23 studies evaluated knee OA; one knee OA or chronic low back pain; two knee or hip OA; one hip OA only; and one thumb OA. No studies identified a dose, duration or type of exercise that resulted in better pain or function outcomes. Core treatments generally showed modest benefits compared to no or minimal intervention controls. CONCLUSIONS Rehabilitation research continues to be focused on the knee. Most studies are not adequately powered to assess pain efficacy. Further work is needed to better account for contextual effects, identify treatment responder characteristics, understand treatment mechanisms, and implement guideline care.
Collapse
Affiliation(s)
- E M Macri
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of General Practice, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
| | - R W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands.
| | - J J Stefanik
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA, USA.
| | - M Reijman
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
| |
Collapse
|
7
|
Dissanayaka T, Nakandala P, Malwanage K, Hill AT, Ashthree DN, Lane MM, Travicia N, Gamage E, Marx W, Jaberzadeh S. The effects of anodal tDCS on pain reduction in people with knee osteoarthritis: A systematic review and meta-analysis. Neurophysiol Clin 2023; 53:102921. [PMID: 37984240 DOI: 10.1016/j.neucli.2023.102921] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVES To synthesise the literature on the efficacy of primary motor cortex anodal transcranial direct current stimulation (M1-a-tDCS), as a standalone or priming technique, for pain reduction in people with knee osteoarthritis (KOA). METHODS The systematic literature search was conducted in MEDLINE, CINAHL, Embase and CENTRAL according to PRISMA statement. RESULTS Fourteen studies involving 740 people with KOA were included. In the meta-analysis, six studies compared a-tDCS alone with sham stimulation, and five studies compared a-tDCS combined with other methods with sham stimulation. We found positive effect of a-tDCS alone on pain in KOA (standard mean difference (SMD) -0.52; 95% CI, -0.78 to -0.25; P=0.001; I2 = 69%). Further, a-tDCS with other treatments showed positive effect (SMD -1.23; 95% CI, -1.59 to -0.88; P<0.001; I2 = 48%) on pain in people with KOA. This evidence showed low certainty due to a high risk of bias and imprecision. DISCUSSION AND CONCLUSION A-tDCS could be considered as standalone and an adjunct treatment for pain reduction in people with KOA. Future randomised studies should address quality issues, including small sample size, to enhance the overall certainty of the findings. SIGNIFICANCE A-tDCS can be used as a standalone and adjunct treatment for KOA. STUDY REGISTRATION PROSPERO number CRD42021255114.
Collapse
Affiliation(s)
- Thusharika Dissanayaka
- Monash Neuromodulation Research Unit, Department of Physiotherapy, School of Primary Healthcare, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Deakin University, IMPACT (the Institute for Mental and Physical Health and Clinical Translation), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia.
| | | | - Kavinda Malwanage
- Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Sri Lanka
| | - Aron T Hill
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Melbourne, Australia; Department of Psychiatry, Central Clinical School, Monash University, Melbourne, Australia
| | - Deborah N Ashthree
- Deakin University, IMPACT (the Institute for Mental and Physical Health and Clinical Translation), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Melissa M Lane
- Deakin University, IMPACT (the Institute for Mental and Physical Health and Clinical Translation), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Nikolaj Travicia
- Deakin University, IMPACT (the Institute for Mental and Physical Health and Clinical Translation), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Elizabeth Gamage
- Deakin University, IMPACT (the Institute for Mental and Physical Health and Clinical Translation), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Wolfgang Marx
- Deakin University, IMPACT (the Institute for Mental and Physical Health and Clinical Translation), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Shapour Jaberzadeh
- Monash Neuromodulation Research Unit, Department of Physiotherapy, School of Primary Healthcare, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| |
Collapse
|
8
|
Yoon IA, Galarneau D. Chronic pain outcomes of patients receiving electroconvulsive therapy: A systematic review and case series. Pain Pract 2023; 23:942-955. [PMID: 37434489 DOI: 10.1111/papr.13268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/04/2023] [Accepted: 06/20/2023] [Indexed: 07/13/2023]
Abstract
INTRODUCTION The potential benefits of electroconvulsive therapy (ECT) in chronic pain and several theories for its mechanism have been reported in the past, but mixed findings have also been reported. In the current systematic review and case series, our primary aim was to assess whether pain and functional outcomes are improved after ECT in patients with chronic pain. Secondary objectives included examining whether psychiatric improvement, specific pain diagnoses, and demographic or medical characteristics were associated with differences in pain treatment response. METHODS We performed a retrospective chart review to identify patients with chronic pain diagnoses for more than 3 months prior to the initiation of ECT and a systematic literature search on electronic databases for studies on chronic pain outcomes after ECT. RESULTS Eleven patients with various chronic pain diagnoses and comorbid psychiatric conditions were identified in the case series. Six patients reported improvement in pain while 10 patients reported improvement in mood following ECT. Systematic review identified 22 articles reporting a total of 109 cases. Eighty-five (78%) of cases reported reduction in pain while 96.3% of the patients with a comorbid psychiatric diagnosis reported improvement in mood symptoms post-ECT. While there was an association between improvement in mood and pain in studies with numeric ratings in both outcomes (r = 0.61; p < 0.001), some patients reported pain improvement without improvement in mood in both the case series and the pooled analysis of cases in the review. Certain pain diagnoses such as CRPS, phantom limb pain, neuropathic pain, and low back pain have consistently reported benefits and should be further studied in future studies with matched case controls. CONCLUSION ECT may be offered to patients with certain pain conditions who have not responded sufficiently to conventional therapies, particularly when comorbid mood symptoms are present. Improved documentation practices on the outcomes in chronic pain patients receiving ECT will help generate more studies that are needed on this topic.
Collapse
Affiliation(s)
- Isabel A Yoon
- Ochsner Clinical School, University of Queensland, New Orleans, Louisiana, USA
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - David Galarneau
- Ochsner Clinical School, University of Queensland, New Orleans, Louisiana, USA
- Department of Psychiatry, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| |
Collapse
|
9
|
Guízar-Sahagún G, Grijalva I, Franco-Bourland RE, Madrazo I. Aging with spinal cord injury: A narrative review of consequences and challenges. Ageing Res Rev 2023; 90:102020. [PMID: 37487887 DOI: 10.1016/j.arr.2023.102020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/12/2023] [Accepted: 07/19/2023] [Indexed: 07/26/2023]
Abstract
Given the increase in life expectancy, aging with a pre-existing spinal cord injury (SCI) is becoming more common. This condition is challenging as compromised health status and functional independence can worsen. We aimed to provide an updated overview of the consequences of aging with SCI, highlighting the main challenges facing this population in a narrative review of the current literature we retrieved from the PubMed database from 2000 to 2022 on any aspect related to aging in persons with SCI. Here we address adverse circumstances that increase disability and hinder an active lifestyle, such as progressive physical deterioration, secondary health conditions, limitations in personal activity, changes in family and social support structures, aging of caregivers, and depletion of economic resources. Favorable changes are also observed, including psychosocial adjustments that improve quality of life. Additionally, various interventions are discussed to promote well-being, health, and social participation. Due to the relevance of this issue, people with SCI and all those who take care of them must have up-to-date information to carry out the necessary measures to promote healthy aging in a more inclusive social environment.
Collapse
Affiliation(s)
- Gabriel Guízar-Sahagún
- Research Unit for Neurological Diseases, Instituto Mexicano del Seguro Social, 4430 Calzada de Tlalpan, Mexico City, Mexico.
| | - Israel Grijalva
- Research Unit for Neurological Diseases, Instituto Mexicano del Seguro Social, 4430 Calzada de Tlalpan, Mexico City, Mexico
| | - Rebecca E Franco-Bourland
- Department of Biochemistry, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, 289 Calzada México-Xochimilco, Mexico City, Mexico
| | - Ignacio Madrazo
- Research Unit for Neurological Diseases, Instituto Mexicano del Seguro Social, 4430 Calzada de Tlalpan, Mexico City, Mexico
| |
Collapse
|
10
|
Agostinho M, Weissman Fogel I, Treister R. Time since onset might be of essence: A recommendation to assess the effects of combination of non-pharmacological neuromodulatory approaches at early stage since symptoms onset. Front Neurol 2023; 14:1115370. [PMID: 36793488 PMCID: PMC9923174 DOI: 10.3389/fneur.2023.1115370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/11/2023] [Indexed: 01/31/2023] Open
Abstract
In the past decade researchers began to assess the potential beneficial effects of non-invasive brain stimulation (NIBS) combined with a behavioral task as a treatment approach for various medical conditions. Transcranial direct current stimulation (tDCS) applied to the motor cortex combined with another treatment approach has been assessed as analgesic treatment in neuropathic and non-neuropathic pain conditions, and was found to exert only modest pain relief. Our group results show that combined tDCS and mirror therapy dramatically reduced acute phantom limb pain intensity with long-lasting effects, potentially preventing pain chronification. A review of the scientific literature indicates that our approach differs from that of others: We applied the intervention at the acute stage of the disease, whereas other studies applied the intervention in patients whose disease had already been established. We suggest that the timing of administration of the combined intervention is critical. Unlike in patients with chronic painful condition, in which the maladaptive plasticity associated with pain chronification and chronicity is well-consolidated, early treatment at the acute pain stage may be more successful in counterbalancing the not-yet consolidated maladaptive plasticity. We encourage the research community to test our hypothesis, both in the treatment of pain, and beyond.
Collapse
Affiliation(s)
- Mariana Agostinho
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
- Centre for Interdisciplinary Health Research, CIIS, Institute of Health Sciences, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Irit Weissman Fogel
- Physical Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Roi Treister
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| |
Collapse
|
11
|
Abstract
PURPOSE OF REVIEW To review advances in the diagnostic evaluation and management of traumatic peripheral nerve injuries. RECENT FINDINGS Serial multimodal assessment of peripheral nerve injuries facilitates assessment of spontaneous axonal regeneration and selection of appropriate patients for early surgical intervention. Novel surgical and rehabilitative approaches have been developed to complement established strategies, particularly in the area of nerve grafting, targeted rehabilitation strategies and interventions to promote nerve regeneration. However, several management challenges remain, including incomplete reinnervation, traumatic neuroma development, maladaptive central remodeling and management of fatigue, which compromise functional recovery. SUMMARY Innovative approaches to the assessment and treatment of peripheral nerve injuries hold promise in improving the degree of functional recovery; however, this remains a complex and evolving area.
Collapse
|
12
|
Navarro-López V, Del-Valle-Gratacós M, Fernández-Vázquez D, Fernández-González P, Carratalá-Tejada M, Molina-Rueda F. Transcranial direct current stimulation in the management of phantom limb pain: a systematic review of randomized controlled trials. Eur J Phys Rehabil Med 2022; 58:738-748. [PMID: 35758072 PMCID: PMC10019480 DOI: 10.23736/s1973-9087.22.07439-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 06/13/2022] [Accepted: 06/20/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Phantom limb pain (PLP) after amputation is a frequent entity that conditions the life of those who suffer it. Current treatment methods are not sufficiently effective for PLP management. We aim to analyze the clinical application of transcranial direct current (tDCS) in people with amputation suffering from PLP. EVIDENCE ACQUISITION The following databases were consulted in September 2021: MEDLINE, EMBASE, The Web of Science, PEDro, SCOPUS and SciELO. Randomized controlled trials investigating the use of tDCS in people with amputation undergoing PLP were selected. Demographic data, type and cause of amputation, time since amputation, stimulation parameters, and outcomes were extracted. EVIDENCE SYNTHESIS Six articles were included in this review (seven studies were considered because one study performed two individual protocols). All included studies evaluated PLP; six evaluated the phantom limb sensations (PLS) and two evaluated the psychiatric disorders. In all included studies the intensity and frequency of PLP was reduced, in three PLS were reduced, and in none study psychiatric symptoms were modified. CONCLUSIONS Anodic tDCS over the contralateral M1 to the affected limb, with an intensity of 1-2 mA, for 15-20 minutes seems to significantly reduce PLP in people with amputation. Single-session treatment could modify PLP intensity for hours, and multi-session treatment could modify PLP for months. Limited evidence suggests that PLS and psychiatric disorders should be treated with different PLP electrode placements. Further studies with larger sample size and longer follow-up times are needed to establish the priority of tDCS application in the PLP management.
Collapse
Affiliation(s)
- Víctor Navarro-López
- Motion Analysis, Biomechanics, Ergonomy and Motor Control Laboratory (LAMBECOM group), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, Alcorcón, Madrid, Spain
- International Doctoral School, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | | | - Diego Fernández-Vázquez
- Motion Analysis, Biomechanics, Ergonomy and Motor Control Laboratory (LAMBECOM group), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, Alcorcón, Madrid, Spain
- International Doctoral School, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Pilar Fernández-González
- Motion Analysis, Biomechanics, Ergonomy and Motor Control Laboratory (LAMBECOM group), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - María Carratalá-Tejada
- Motion Analysis, Biomechanics, Ergonomy and Motor Control Laboratory (LAMBECOM group), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, Alcorcón, Madrid, Spain -
| | - Francisco Molina-Rueda
- Motion Analysis, Biomechanics, Ergonomy and Motor Control Laboratory (LAMBECOM group), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| |
Collapse
|
13
|
Adhia DB, Mani R, Reynolds JNJ, Vanneste S, De Ridder D. High-definition transcranial infraslow pink noise stimulation for chronic low back pain: protocol for a pilot, safety and feasibility randomised placebo-controlled trial. BMJ Open 2022; 12:e056842. [PMID: 35705354 PMCID: PMC9204463 DOI: 10.1136/bmjopen-2021-056842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Chronic low back pain (CLBP) is a common disabling health condition. Current treatments demonstrate modest effects, warranting newer therapies. Brain imaging demonstrates altered electrical activities in cortical areas responsible for pain modulation, emotional and sensory components of pain experience. Treatments targeting to change electrical activities of these key brain regions may produce clinical benefits. This pilot study aims to (1) evaluate feasibility, safety and acceptability of a novel neuromodulation technique, high-definition transcranial infraslow pink noise stimulation (HD-tIPNS), in people with CLBP, (2) explore the trend of effect of HD-tIPNS on pain and function, and (3) derive treatment estimates to support sample size calculation for a fully powered trial should trends of effectiveness be present. METHODS AND ANALYSIS A pilot, triple-blinded randomised two-arm placebo-controlled parallel trial. Participants (n=40) with CLBP will be randomised to either sham stimulation or HD-tIPNS (targeting somatosensory cortex and dorsal and pregenual anterior cingulate cortex). Primary outcomes include feasibility and safety measures, and clinical outcomes of pain (Brief Pain Inventory) and disability (Roland-Morris disability questionnaire). Secondary measures include clinical, psychological, quantitative sensory testing and electroencephalography collected at baseline, immediately postintervention, and at 1-week, 1-month and 3 months postintervention. All data will be analysed descriptively. A nested qualitative study will assess participants perceptions about acceptability of intervention and analysed thematically. ETHICS AND DISSEMINATION Ethical approval has been obtained from Health and Disability Ethics Committee (Ref:20/NTB/67). Findings will be reported to regulatory and funding bodies, presented at conferences, and published in a scientific journal. TRIAL REGISTRATION NUMBER ACTRN12620000505909p.
Collapse
Affiliation(s)
- Divya Bharatkumar Adhia
- Department of Surgical Sciences, and Pain@Otago Research Theme, University of Otago - Dunedin Campus, Dunedin, New Zealand
| | - Ramakrishnan Mani
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, and Pain@Otago Research Theme, University of Otago - Dunedin Campus, Dunedin, New Zealand
| | - John N J Reynolds
- Department of Anatomy and the Brain Health Research Centre, University of Otago - Dunedin Campus, Dunedin, New Zealand
| | - Sven Vanneste
- School of Psychology, Global Brain Health Institute, Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Dirk De Ridder
- Department of Surgical Sciences, and Pain@Otago Research Theme, University of Otago - Dunedin Campus, Dunedin, New Zealand
| |
Collapse
|