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Fabris-Moraes W, Lacerda GJM, Pacheco-Barrios K, Fregni F. The Impact of Obesity as a Peripheral Disruptor of Brain Inhibitory Mechanisms in Fibromyalgia: A Cross-Sectional Study. J Clin Med 2024; 13:3878. [PMID: 38999444 PMCID: PMC11242580 DOI: 10.3390/jcm13133878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 06/28/2024] [Accepted: 06/29/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objective: Obesity, characterized by chronic inflammation, may serve as a surrogate marker for more dysfunctional peripheral inflammation, potentially exacerbating FM symptomatology. Given this premise, this study aimed to investigate the effects of obesity as an effect modifier on neural and clinical variables, specifically those indexing pain-compensatory mechanisms in FM symptoms. Methods: A cross-sectional study was conducted with 108 participants who underwent a standardized TMS protocol assessment to measure resting motor threshold (MT), intracortical facilitation (ICF), and intracortical inhibition (ICI). Clinical data were collected using Beck's Depression Index (BDI), PROMIS, the Brief Pain Inventory (BPI), and conditioned pain modulation (CPM). Linear regression models were used to explore the relationship between these variables while examining Body Mass Index (BMI) as a potential effect modifier. If it was found to be a modifier, we stratified the sample into two groups with a BMI cutoff of 30 and performed another regression model within the subgroups. Results: BMI was identified as an effect modifier in the relationships between ICI and BDI, PROMIS fatigue, and CPM and in MT versus CPM. After stratification, non-obese fibromyalgia subjects demonstrated significant correlations between clinical symptoms and CPM and ICI activity. However, these correlations were absent in the obese group, suggesting obesity disrupts pain mechanisms and their compensatory effects. Higher MT values were associated with weaker endogenous pain control, particularly evident in the obese group. Conclusions: Obesity appears to be a significant effect modifier and delineates two patient groups across multiple clinical and neural assessments of fibromyalgia. Additionally, it suggests a role for obesity in exacerbating fibromyalgia symptoms and disrupting physiological pain-inhibitory mechanisms.
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Affiliation(s)
- Walter Fabris-Moraes
- Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA 02129, USA; (W.F.-M.)
- Faculty of Medicine FMUSP, University of São Paulo, São Paulo 01246-903, SP, Brazil
| | - Guilherme J. M. Lacerda
- Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA 02129, USA; (W.F.-M.)
- Faculty of Medicine FMUSP, University of São Paulo, São Paulo 01246-903, SP, Brazil
- Instituto de MedicinaFísica e Reabilitação, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 04116-030, SP, Brazil
| | - Kevin Pacheco-Barrios
- Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA 02129, USA; (W.F.-M.)
- Unidad de Investigación para la Generación y Síntesis de Evidenciasen Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima 150114, Peru
| | - Felipe Fregni
- Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA 02129, USA; (W.F.-M.)
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Herrero Babiloni A, Provost C, Charlebois-Plante C, De Koninck BP, Apinis-Deshaies A, Lavigne GJ, Martel MO, De Beaumont L. One session of repetitive transcranial magnetic stimulation induces mild and transient analgesic effects among female individuals with painful temporomandibular disorders. J Oral Rehabil 2024; 51:827-839. [PMID: 38225806 DOI: 10.1111/joor.13655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/11/2023] [Accepted: 01/05/2024] [Indexed: 01/17/2024]
Abstract
OBJECTIVE Temporomandibular disorders (TMD) are characterised by chronic pain and dysfunction in the jaw joint and masticatory muscles. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a potential non-invasive treatment for chronic pain; however, its effectiveness in individuals with TMD has not been thoroughly investigated. This study aimed to evaluate the immediate and sustained (over seven consecutive days) effects of a single session of active rTMS compared to sham stimulation on pain intensity and pain unpleasantness in individuals with TMD. METHODS A randomised, double-blind, sham-controlled trial enrolled 41 female participants with chronic TMD. Pain intensity and pain unpleasantness were assessed immediately pre- and post-intervention, as well as twice daily for 21 days using electronic diaries. Secondary outcomes included pain interference, sleep quality, positive and negative affect and pain catastrophizing. Adverse effects were monitored. Repeated measures ANOVA and multilevel modelling regression analyses were employed for data analysis. RESULT Active rTMS demonstrated a significant immediate mild reduction in pain intensity and pain unpleasantness compared to sham stimulation. However, these effects were not sustained over the 7-day post-intervention period. No significant differences were observed between interventions for pain interference, sleep quality and negative affect. A minority of participants reported minor and transient side effects, including headaches and fatigue. CONCLUSION A single session of active rTMS was safe and led to immediate mild analgesic effects in individuals with TMD compared to sham stimulation. However, no significant differences were observed between interventions over the 7-day post-intervention period. Based on this study, rTMS stimulation appears to be a promising safe approach to be tested in TMD patients with longer stimulation protocols.
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Affiliation(s)
- Alberto Herrero Babiloni
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Catherine Provost
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Camille Charlebois-Plante
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Beatrice P De Koninck
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Amelie Apinis-Deshaies
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Gilles J Lavigne
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
- Faculty of Dental Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Marc O Martel
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
- Department of Anesthesia, McGill University, Montreal, Quebec, Canada
| | - Louis De Beaumont
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
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Herrero Babiloni A, Jodoin M, Provost C, Charlebois-Plante C, De Koninck BP, Apinis-Deshaies A, Lavigne GJ, De Beaumont L. Females with painful temporomandibular disorders present higher intracortical facilitation relative to pain-free controls. Clin Oral Investig 2023; 28:12. [PMID: 38129743 DOI: 10.1007/s00784-023-05412-5] [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: 10/17/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES This study aimed to investigate cortical excitability differences in the primary motor cortex (M1) hand representation between individuals with temporomandibular disorders (TMD) and healthy controls. We assessed resting motor thresholds, motor-evoked potentials (MEPs), intracortical inhibition, and intracortical facilitation and explored potential associations with clinical and psychosocial characteristics in the TMD group. MATERIALS AND METHODS We recruited 36 female participants with TMD and 17 pain-free controls. Transcranial magnetic stimulation (TMS) was used to assess M1 cortical excitability. Correlations between clinical and psychosocial factors and cortical excitability measures were also evaluated. RESULTS Patients with TMD showed significantly higher intracortical facilitation at 12 ms (z = 1.98, p = 0.048) and 15 ms (z = 2.65, p = 0.008) when compared to controls. Correlations revealed associations between intracortical facilitation and pain interference, sleep quality, depressive symptoms, and pain catastrophizing in the TMD group. CONCLUSIONS Females with TMD exhibit heightened motor cortex intracortical facilitation in the hand representation, potentially indicating altered cortical excitability beyond the motor face area. This suggests a role for cortical excitability in TMD pathophysiology, influenced by psychosocial factors. CLINICAL RELEVANCE Understanding cortical excitability in TMD may inform targeted interventions. Psychosocial variables may play a role in cortical excitability, emphasizing the multidimensional nature of TMD-related pain. Further research is needed to confirm and expand upon these findings, with potential implications for the management of TMD and related pain conditions.
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Affiliation(s)
- Alberto Herrero Babiloni
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada.
- Sacre-Coeur Hospital, CIUSSS NIM Research Center, CEAMS, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada.
| | - Marianne Jodoin
- Sacre-Coeur Hospital, CIUSSS NIM Research Center, CEAMS, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Catherine Provost
- Sacre-Coeur Hospital, CIUSSS NIM Research Center, CEAMS, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada
| | - Camille Charlebois-Plante
- Sacre-Coeur Hospital, CIUSSS NIM Research Center, CEAMS, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Beatrice P De Koninck
- Sacre-Coeur Hospital, CIUSSS NIM Research Center, CEAMS, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Amelie Apinis-Deshaies
- Sacre-Coeur Hospital, CIUSSS NIM Research Center, CEAMS, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada
| | - Gilles J Lavigne
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Sacre-Coeur Hospital, CIUSSS NIM Research Center, CEAMS, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada
- Faculty of Dental Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Louis De Beaumont
- Sacre-Coeur Hospital, CIUSSS NIM Research Center, CEAMS, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
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Snow NJ, Kirkland MC, Downer MB, Murphy HM, Ploughman M. Transcranial magnetic stimulation maps the neurophysiology of chronic noncancer pain: A scoping review. Medicine (Baltimore) 2022; 101:e31774. [PMID: 36401490 PMCID: PMC9678597 DOI: 10.1097/md.0000000000031774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Chronic noncancer pain is a global public health challenge. It is imperative to identify biological markers ("biomarkers") to understand the mechanisms underlying chronic pain and to monitor pain over time and after interventions. Transcranial magnetic stimulation (TMS) is a promising method for this purpose. OBJECTIVES To examine differences in TMS-based outcomes between persons with chronic pain and healthy controls (HCs) and/or before versus after pain-modulating interventions and relationships between pain measures and TMS outcomes; To summarize the neurophysiological mechanisms underlying chronic pain as identified by TMS. METHODS We searched the PubMed database for literature from January 1, 1985, to June 9, 2020, with the keywords "pain" and "transcranial magnetic stimulation." Eligible items included original studies of adult human participants with pain lasting for ≥ 6 months. We completed a narrative synthesis of the study findings stratified by chronic pain etiology (primary pain, neuropathic pain, and secondary musculoskeletal pain). RESULTS The search yielded 1265 records. The final 12 articles included 244 patients with chronic pain (192 females, aged 35-65 years) and 169 HCs (89 females, aged 28-59 years). Abnormalities in TMS outcomes that reflect GABAergic and glutamatergic activities were associated with many of the disorders studied and were distinct for each pain etiology. Chronic primary pain is characterized by reduced intracortical inhibition and corticospinal excitability, chronic neuropathic pain shows evidence of increased excitation and disinhibition, and chronic secondary musculoskeletal pain involves low corticospinal excitability. DISCUSSION TMS could be a useful tool for delineating the neurophysiological underpinnings of chronic pain syndromes.
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Affiliation(s)
- Nicholas Jacob Snow
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland & Labrador, St. John’s, NL, Canada
| | - Megan Christine Kirkland
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland & Labrador, St. John’s, NL, Canada
| | - Matthew Bruce Downer
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland & Labrador, St. John’s, NL, Canada
| | - Hannah Margaret Murphy
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland & Labrador, St. John’s, NL, Canada
| | - Michelle Ploughman
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland & Labrador, St. John’s, NL, Canada
- * Correspondence: Michelle Ploughman, Recovery and Performance Laboratory, Rehabilitation Research Unit of NL, Faculty of Medicine, Memorial University of Newfoundland & Labrador, Dr. Leonard A. Miller Centre, Room 400, 100 Forest Road, St. John’s, Newfoundland and Labrador A1A 1E5, Canada (e-mail: )
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Millard SK, Bokelmann K, Schalbroeck R, van der Wee NJA, van Loey NEE, van Laarhoven AIM. No indications for altered EEG oscillatory activity in patients with chronic post-burn itch compared to healthy controls. Sci Rep 2022; 12:5184. [PMID: 35338171 PMCID: PMC8956573 DOI: 10.1038/s41598-022-08742-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 02/14/2022] [Indexed: 11/23/2022] Open
Abstract
A large proportion of patients with burn injuries develop chronic itch, which impacts quality of life. The underlying pathophysiological mechanisms are poorly understood. This cross-sectional pilot study investigates whether altered cortical oscillatory processes are involved in chronic post-burn itch. Continuous electroencephalography (EEG) data were recorded during rest and stimulation of non-injured skin, inducing itch (histamine and electrical) and cold-pressor task pain for 15 adults with chronic post-burn itch and 15 matched healthy controls. Quantitative metrics comprised oscillatory power and peak frequencies in theta, alpha, and beta bands. No statistical differences between patients and healthy controls were found in oscillatory activity during rest or stimulation, with Bayesian analysis suggesting equivocal evidence. However, post-traumatic stress symptoms and duration of chronic itch may be associated with changes in oscillatory activity. A lack of differences in cortical oscillatory processing and itch levels at non-injured sites, suggests that itch symptoms have a localised character in this sample of patients with post-burn itch. For future studies, a biopsychological approach with integration of peripheral and central nervous system techniques, linear and non-linear EEG analysis, injured and non-injured stimulation sites, and incorporation of individual characteristics is recommended. Insight into pathophysiological mechanisms underlying chronic post-burn itch could improve diagnostics and treatments.
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Affiliation(s)
- Samantha K Millard
- Health, Medical, and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands.,Centre for Pain IMPACT, Neuroscience Research Australia, 139 Barker Street, Randwick, Sydney, NSW, 2031, Australia.,School of Medical Science, Faculty of Medicine, University of New South Wales, 18 High St, Kensington, Sydney, NSW, 2052, Australia
| | - Klara Bokelmann
- Health, Medical, and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
| | - Rik Schalbroeck
- Health, Medical, and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
| | - Nic J A van der Wee
- Department of Psychiatry, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Nancy E E van Loey
- Association of Dutch Burn Centers, Maasstad Hospital, Burn Center, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands.,Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands
| | - Antoinette I M van Laarhoven
- Health, Medical, and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands. .,Department of Psychiatry, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. .,Leiden Institute for Brain and Cognition (LIBC), Leiden University, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
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Simis M, Imamura M, Sampaio de Melo P, Marduy A, Battistella L, Fregni F. Deficit of Inhibition as a Marker of Neuroplasticity (DEFINE Study) in Rehabilitation: A Longitudinal Cohort Study Protocol. Front Neurol 2021; 12:695406. [PMID: 34434160 PMCID: PMC8380986 DOI: 10.3389/fneur.2021.695406] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/21/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Brain plasticity is an intrinsic property of the nervous system, which is modified during its lifetime. This is one mechanism of recuperation after injuries with an important role in rehabilitation. Evidence suggests that injuries in the nervous system disturb the stability between inhibition and excitability essential for the recuperation process of neuroplasticity. However, the mechanisms involved in this balance are not completely understood and, besides the advancement in the field, the knowledge has had a low impact on the rehabilitation practice. Therefore, the understanding of the relationship between biomarkers and functional disability may help to optimize and individualize treatments and build consistent studies in the future. Methods: This cohort study, the deficit of inhibition as a marker of neuroplasticity study, will follow four groups (stroke, spinal cord injury, limb amputation, and osteoarthritis) to understand the neuroplasticity mechanisms involved in motor rehabilitation. We will recruit 500 subjects (including 100 age- and sex-matched controls). A battery of neurophysiological assessments, transcranial magnetic stimulation, electroencephalography, functional near-infrared spectroscopy, and magnetic resonance imaging, is going to be used to assess plasticity on the motor cortex before and after rehabilitation. One of the main hypotheses in this cohort is that the level of intracortical inhibition is related to functional deficits. We expect to develop a better understanding of the neuroplasticity mechanisms involved in the rehabilitation, and we expect to build neurophysiological “transdiagnostic” biomarkers, especially the markers of inhibition, which will have great relevance in the scientific and therapeutic improvement in rehabilitation. The relationship between neurophysiological and clinical outcomes will be analyzed using linear and logistic regression models. Discussion: By evaluating the reliability of electroencephalography, functional near-infrared spectroscopy, transcranial magnetic stimulation, and magnetic resonance imaging measures as possible biomarkers for neurologic rehabilitation in different neurologic disorders, this study will aid in the understanding of brain plasticity mechanisms in rehabilitation, allowing more effective approaches and screening methods to take place.
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Affiliation(s)
- Marcel Simis
- Núcleo de Estudos Avançados em Reabilitação, Universidade de São Paulo, São Paulo, Brazil
| | - Marta Imamura
- Núcleo de Estudos Avançados em Reabilitação, Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Sampaio de Melo
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Anna Marduy
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Linamara Battistella
- Núcleo de Estudos Avançados em Reabilitação, Universidade de São Paulo, São Paulo, Brazil
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Boston, MA, United States
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Teixeira M, Mancini C, Wicht CA, Maestretti G, Kuntzer T, Cazzoli D, Mouthon M, Annoni JM, Chabwine JN. Beta Electroencephalographic Oscillation Is a Potential GABAergic Biomarker of Chronic Peripheral Neuropathic Pain. Front Neurosci 2021; 15:594536. [PMID: 33716642 PMCID: PMC7952534 DOI: 10.3389/fnins.2021.594536] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/25/2021] [Indexed: 01/21/2023] Open
Abstract
This preliminary investigation aimed to assess beta (β) oscillation, a marker of the brain GABAergic signaling, as a potential objective pain marker, hence contributing at the same time to the mechanistic approach of pain management. This case–control observational study measured β electroencephalographic (EEG) oscillation in 12 right-handed adult male with chronic neuropathic pain and 10 matched controls (∼55 years). Participants were submitted to clinical evaluation (pain visual analog scale, Hospital Anxiety, and Depression scale) and a 24-min high-density EEG recording (BIOSEMI). Data were analyzed using the EEGlab toolbox (MATLAB), SPSS, and R. The global power spectrum computed within the low (Lβ, 13–20 Hz) and the high (Hβ, 20–30 Hz) β frequency sub-bands was significantly lower in patients than in controls, and accordingly, Lβ was negatively correlated to the pain visual analog scale (R = −0.931, p = 0.007), whereas Hβ correlation was at the edge of significance (R = −0.805; p = 0.053). Patients’ anxiety was correlated to pain intensity (R = 0.755; p = 0.003). Normalization of the low and high β global power spectrum (GPS) to the GPS of the full frequency range, while confirming the significant Lβ power decrease in chronic neuropathic pain patients, vanished the significance of the Hβ decrease, as well as the correlation between Lβ power and pain intensity. Our results suggest that the GABAergic Lβ EEG oscillation is affected by chronic neuropathic pain. Confirming the Lβ GPS decrease and the correlation with pain intensity in larger studies would open new opportunities for the clinical application of gamma-aminobutyric acid-modifying therapies.
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Affiliation(s)
- Micael Teixeira
- Neurology Unit, Medicine Section, Laboratory for Cognitive and Neurological Science, Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland.,Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Christian Mancini
- Neurology Unit, Medicine Section, Laboratory for Cognitive and Neurological Science, Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Corentin Aurèle Wicht
- Neurology Unit, Medicine Section, Laboratory for Cognitive and Neurological Science, Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | | | - Thierry Kuntzer
- Nerve-Muscle Unit, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Dario Cazzoli
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.,Perception and Eye Movement Laboratory, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Mouthon
- Neurology Unit, Medicine Section, Laboratory for Cognitive and Neurological Science, Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Jean-Marie Annoni
- Neurology Unit, Medicine Section, Laboratory for Cognitive and Neurological Science, Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Joelle Nsimire Chabwine
- Neurology Unit, Medicine Section, Laboratory for Cognitive and Neurological Science, Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland.,Division of Neurorehabilitation, Fribourg Hospital, Fribourg, Switzerland
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8
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Teixeira PEP, Pacheco-Barrios K, Gunduz ME, Gianlorenço AC, Castelo-Branco L, Fregni F. Understanding intracortical excitability in phantom limb pain: A multivariate analysis from a multicenter randomized clinical trial. Neurophysiol Clin 2021; 51:161-173. [PMID: 33648819 DOI: 10.1016/j.neucli.2020.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES To explore associations of intracortical excitability with clinical characteristics in a large sample of subjects with phantom limb pain (PLP). METHODS Ancillary study using baseline and longitudinal data from a large multicenter randomized trial that investigated the effects of non-invasive brain stimulation combined with sensorimotor training on PLP. Multivariate regression modeling analyses were used to investigate the association of intracortical excitability, measured by percentages of intracortical inhibition (ICI) and facilitation (ICF) with clinical variables. RESULTS Ninety-eight subjects were included. Phantom sensation of itching was positively associated with ICI changes and at baseline in the affected hemisphere (contralateral to PLP). However, in the non-affected hemisphere (ipsilateral to PLP), the phantom sensation of warmth and PLP intensity were negatively associated with ICI (both models). For the ICF, PLP intensity (baseline model only) and age (longitudinal model) were negatively associated, while time since amputation and amputation level (both for longitudinal model only) were positively associated in the affected hemisphere. Additionally, use of antidepressants led to lower ICF in the non-affected hemisphere for the baseline model while higher amputation level also led to less changes in the ICF. CONCLUSION Results revealed clear associations of clinical variables and cortical excitability in a large chronic pain sample. ICI and ICF changes appear not to be mainly explained by PLP intensity. Instead, other variables associated with duration of neuroplasticity changes (such as age and duration of amputation) and compensatory mechanisms (such as itching and phantom limb sensation) seem to be more important in explaining these variables.
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Affiliation(s)
- Paulo E P Teixeira
- Neuromodulation and Clinical Research Learning Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA; MGH Institute of Health Professions, Boston, MA, USA; Instituto Wilson Mello, Campinas, SP, Brazil.
| | - Kevin Pacheco-Barrios
- Neuromodulation and Clinical Research Learning Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA; Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Muhammed Enes Gunduz
- Neuromodulation and Clinical Research Learning Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Anna Carolyna Gianlorenço
- Neuromodulation and Clinical Research Learning Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA; Laboratory of neuroscience, Department of Physical Therapy, Federal University of Sao Carlos, SP, Brazil
| | - Luis Castelo-Branco
- Neuromodulation and Clinical Research Learning Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Felipe Fregni
- Neuromodulation and Clinical Research Learning Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA; Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Lei K, Kunnel A, Metzger-Smith V, Golshan S, Javors J, Wei J, Lee R, Vaninetti M, Rutledge T, Leung A. Diminished corticomotor excitability in Gulf War Illness related chronic pain symptoms; evidence from TMS study. Sci Rep 2020; 10:18520. [PMID: 33116195 PMCID: PMC7595115 DOI: 10.1038/s41598-020-75006-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/29/2020] [Indexed: 01/06/2023] Open
Abstract
Chronic diffuse body pain is unequivocally highly prevalent in Veterans who served in the 1990-91 Persian Gulf War and diagnosed with Gulf War Illness (GWI). Diminished motor cortical excitability, as a measurement of increased resting motor threshold (RMT) with transcranial magnetic stimulation (TMS), is known to be associated with chronic pain conditions. This study compared RMT in Veterans with GWI related diffuse body pain including headache, muscle and joint pain with their military counterparts without GWI related diffuse body pain. Single pulse TMS was administered over the left motor cortex, using anatomical scans of each subject to guide the TMS coil, starting at 25% of maximum stimulator output (MSO) and increasing in steps of 2% until a motor response with a 50 µV peak to peak amplitude, defined as the RMT, was evoked at the contralateral flexor pollicis brevis muscle. RMT was then analyzed using Repeated Measures Analysis of Variance (RM-ANOVA). Veterans with GWI related chronic headaches and body pain (N = 20, all males) had a significantly (P < 0.001) higher average RMT (% ± SD) of 77.2% ± 16.7% compared to age and gender matched military controls (N = 20, all males), whose average was 55.6% ± 8.8%. Veterans with GWI related diffuse body pain demonstrated a state of diminished corticomotor excitability, suggesting a maladaptive supraspinal pain modulatory state. The impact of this observed supraspinal functional impairment on other GWI related symptoms and the potential use of TMS in rectifying this abnormality and providing relief for pain and co-morbid symptoms requires further investigation.Trial registration: This study was registered on January 25, 2017, on ClinicalTrials.gov with the identifier: NCT03030794. Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT03030794 .
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Affiliation(s)
- Karen Lei
- Veterans Medical Research Foundation, 3350 La Jolla Village Dr (151A), Building 13, San Diego, CA, 92161, USA.,College of Medicine, California Northstate University, 9700 W Taron Dr, Elk Grove, CA, 95757, USA
| | - Alphonsa Kunnel
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
| | - Valerie Metzger-Smith
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
| | - Shahrokh Golshan
- Veterans Medical Research Foundation, 3350 La Jolla Village Dr (151A), Building 13, San Diego, CA, 92161, USA
| | - Jennifer Javors
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
| | - Jennie Wei
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
| | - Roland Lee
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
| | - Michael Vaninetti
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
| | - Thomas Rutledge
- Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
| | - Albert Leung
- Veterans Medical Research Foundation, 3350 La Jolla Village Dr (151A), Building 13, San Diego, CA, 92161, USA. .,Center for Pain and Headache Research, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA. .,School of Medicine, Department of Anesthesiology, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
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10
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Pacheco-Barrios K, Cardenas-Rojas A, Thibaut A, Costa B, Ferreira I, Caumo W, Fregni F. Methods and strategies of tDCS for the treatment of pain: current status and future directions. Expert Rev Med Devices 2020; 17:879-898. [PMID: 32845195 PMCID: PMC7674241 DOI: 10.1080/17434440.2020.1816168] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 08/25/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Transcranial direct current stimulation (tDCS) is a noninvasive neuromodulation technique that has been widely studied for the treatment of chronic pain. It is considered a promising and safe alternative pain therapy. Different targets have been tested, each having their own particular mechanisms for modulating pain perception. AREAS COVERED We discuss the current state of the art of tDCS to manage pain and future strategies to optimize tDCS' effects. Current strategies include primary motor cortex tDCS, prefrontal tDCS and tDCS combined with behavioral interventions while future strategies, on the other hand, include high-intensity tDCS, transcutaneous spinal direct current stimulation, cerebellar tDCS, home-based tDCS, and tDCS with extended number of sessions. EXPERT COMMENTARY It has been shown that the stimulation of the prefrontal and primary motor cortex is efficient for pain reduction while a few other new strategies, such as high-intensity tDCS and network-based tDCS, are believed to induce strong neuroplastic effects, although the underlying neural mechanisms still need to be fully uncovered. Hence, conventional tDCS approaches demonstrated promising effects to manage pain and new strategies are under development to enhance tDCS effects and make this approach more easily available by using, for instance, home-based devices.
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Affiliation(s)
- Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud. Lima, Peru
| | - Alejandra Cardenas-Rojas
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aurore Thibaut
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA
- Coma Science Group, GIGA Consciousness, University of Liege, Liège, Belgium
| | - Beatriz Costa
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Isadora Ferreira
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Wolnei Caumo
- Pain and Palliative Care Service at Hospital de Clínicas de Porto Alegre (HCPA), Laboratory of Pain and Neuromodulation at UFRGS, Porto Alegre, Brazil
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA
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Abstract
PURPOSE OF REVIEW Myofascial pain syndrome (MPS) is a musculoskeletal pain condition that stems from localized, taut regions of skeletal muscle and fascia, termed trigger points. The purpose of this comprehensive review is to provide updated information on prevalence, pathophysiology, and treatment modalities with a focus on interventional modalities in managing MPS. RECENT FINDINGS Though MPS can present acutely, it frequently presents as a chronic condition, affecting up to 85% of adults during their lifetime. MPS is an often-overlooked component of pain with overarching effects on society, including patient quality of life, physical and social functioning, emotional well-being, energy, and costs on health care. The prevalence of MPS is generally increased among patients with other chronic pain disorders and has been associated with various other conditions such as bladder pain syndrome, endometriosis, and anxiety. MPS is poorly understood and remains a challenging condition to treat. Non-pharmacologic treatment modalities such as acupuncture, massage, transcutaneous electrical stimulation, and interferential current therapy may offer relief to some patients with MPS. Additional studies are warranted to get a better understanding of managing myofascial pain.
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Miller JS, Rodriguez-Saona L, Hackshaw KV. Metabolomics in Central Sensitivity Syndromes. Metabolites 2020; 10:E164. [PMID: 32344505 PMCID: PMC7240948 DOI: 10.3390/metabo10040164] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/11/2020] [Accepted: 04/19/2020] [Indexed: 01/09/2023] Open
Abstract
Central sensitization syndromes are a collection of frequently painful disorders that contribute to decreased quality of life and increased risk of opiate abuse. Although these disorders cause significant morbidity, they frequently lack reliable diagnostic tests. As such, technologies that can identify key moieties in central sensitization disorders may contribute to the identification of novel therapeutic targets and more precise treatment options. The analysis of small molecules in biological samples through metabolomics has improved greatly and may be the technology needed to identify key moieties in difficult to diagnose diseases. In this review, we discuss the current state of metabolomics as it relates to central sensitization disorders. From initial literature review until Feb 2020, PubMed, Embase, and Scopus were searched for applicable studies. We included cohort studies, case series, and interventional studies of both adults and children affected by central sensitivity syndromes. The majority of metabolomic studies addressing a CSS found significantly altered metabolites that allowed for differentiation of CSS patients from healthy controls. Therefore, the published literature overwhelmingly supports the use of metabolomics in CSS. Further research into these altered metabolites and their respective metabolic pathways may provide more reliable and effective therapeutics for these syndromes.
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Affiliation(s)
- Joseph S. Miller
- Department of Medicine, Ohio University Heritage College of Osteopathic Medicine, Dublin, OH 43016, USA;
| | - Luis Rodriguez-Saona
- Department of Food Science and Technology, Ohio State University, Columbus, OH 43210, USA;
| | - Kevin V. Hackshaw
- Department of Internal Medicine, Division of Rheumatology, Dell Medical School, The University of Texas, 1701 Trinity St, Austin, TX 78712, USA
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Cao L, Gao Y, Wu K, Li Y, Chen C, Yuan S. Sympathetic hyperinnervation in myofascial trigger points. Med Hypotheses 2020; 139:109633. [PMID: 32087493 DOI: 10.1016/j.mehy.2020.109633] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/09/2020] [Accepted: 02/13/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To evaluate the local distribution and activity of sympathetic nerves in myofascial trigger points (MTrPs) and explore the pathological mechanism of myofascial pain syndrome (MPS) using a rat model of disease. METHODS MPS was modeled in the model group (MG) by a combination of blunt trauma and eccentric exercise in Sprague-Dawley rats (n = 8). Eight rats were randomly assigned to the control group (CG). Histopathology was applied to detect the local conditions of the MTrPs. Tyrosine hydroxylase (TH), nerve growth factor (NGF), and norepinephrine (NE) were detected in the MTrPs to evaluate sympathetic remodeling. RESULTS Muscle fiber rupture, atrophy and shape irregularity were universally observed in the MTrPs. TH expression was significantly increased in the MG, as detected by immunofluorescence, and NGF and TH expression was also higher in MTrPs in the MG than in MTrPs in the CG, as determined by immunohistochemistry. Furthermore, the expression of NE was significantly increased in MTrPs, as determined by ELISA. CONCLUSION There was sympathetic hyperinnervation in MTrPs, which could partially explain the symptoms of MTrPs and is an interesting and useful new perspective regarding the diagnosis and treatment of MPS. PERSPECTIVE The sympathetic nerves in MTrPs are remodeled, leading to sympathetic hyperinnervation. Sympathetic hyperinnervation can partially explain the symptoms of MPS. The pathological mechanism of sympathetic hyperinnervation may be a new perspective for the diagnosis and treatment of MPS.
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Affiliation(s)
- Lei Cao
- Department of Anesthesiology, Hainan Province Hospital of Traditional Chinese Medicine, Haikou, Hainan, China
| | - Yanping Gao
- Academy of Orthopedics, Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Kai Wu
- Department of Orthopaedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Yikai Li
- Academy of Orthopedics, Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China; Department of Orthopaedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Chao Chen
- Department of Orthopaedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Shiguo Yuan
- Academy of Orthopedics, Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China.
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Gentile E, Ricci K, Delussi M, Brighina F, de Tommaso M. Motor Cortex Function in Fibromyalgia: A Study by Functional Near-Infrared Spectroscopy. PAIN RESEARCH AND TREATMENT 2019; 2019:2623161. [PMID: 30792923 PMCID: PMC6354141 DOI: 10.1155/2019/2623161] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/31/2018] [Indexed: 02/07/2023]
Abstract
Previous studies indicated changes of motor cortex excitability in fibromyalgia (FM) patients and the positive results of transcranial stimulation techniques. The present study aimed to explore the metabolism of motor cortex in FM patients, in resting state and during slow and fast finger tapping, using functional Near-Infrared Spectroscopy (fNIRS), an optical method which detects in real time the metabolism changes in the cortical tissue. We studied 24 FM patients and 24 healthy subjects. We found a significant slowness of motor speed in FM patients compared to controls. During resting state and slow movement conditions, the metabolism of the motor areas was similar between groups. The oxyhemoglobin concentrations were significantly lower in patients than in control group during the fast movement task. This abnormality was independent from FM severity and duration. The activation of motor cortex areas is dysfunctional in FM patients, thus supporting the rationale for the therapeutic role of motor cortex modulation in this disabling disorder.
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Affiliation(s)
- Eleonora Gentile
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Bari Aldo Moro University, Polyclinic General Hospital, Via Amendola 207 A, 70123 Bari, Italy
| | - Katia Ricci
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Bari Aldo Moro University, Polyclinic General Hospital, Via Amendola 207 A, 70123 Bari, Italy
| | - Marianna Delussi
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Bari Aldo Moro University, Polyclinic General Hospital, Via Amendola 207 A, 70123 Bari, Italy
| | - Filippo Brighina
- Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of Palermo, Via del Vespro 143, 90127 Palermo, Italy
| | - Marina de Tommaso
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Bari Aldo Moro University, Polyclinic General Hospital, Via Amendola 207 A, 70123 Bari, Italy
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Botelho L, Angoleri L, Zortea M, Deitos A, Brietzke A, Torres ILS, Fregni F, Caumo W. Insights About the Neuroplasticity State on the Effect of Intramuscular Electrical Stimulation in Pain and Disability Associated With Chronic Myofascial Pain Syndrome (MPS): A Double-Blind, Randomized, Sham-Controlled Trial. Front Hum Neurosci 2018; 12:388. [PMID: 30459575 PMCID: PMC6232764 DOI: 10.3389/fnhum.2018.00388] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 09/06/2018] [Indexed: 12/04/2022] Open
Abstract
Background: There is limited evidence concerning the effect of intramuscular electrical stimulation (EIMS) on the neural mechanisms of pain and disability associated with chronic Myofascial Pain Syndrome (MPS). Objectives: To provide new insights into the EIMS long-term effect on pain and disability related to chronic MPS (primary outcomes). To assess if the neuroplasticity state at baseline could predict the long-term impact of EIMS on disability due to MPS we examined the relationship between the serum brain-derived-neurotrophic-factor (BDNF) and by motor evoked potential (MEP). Also, we evaluated if the EIMS could improve the descending pain modulatory system (DPMS) and the cortical excitability measured by transcranial magnetic stimulation (TMS) parameters. Methods: We included 24 right-handed female with chronic MPS, 19-65 years old. They were randomically allocated to receive ten sessions of EIMS, 2 Hz at the cervical paraspinal region or a sham intervention (n = 12). Results: A mixed model analysis of variance revealed that EIMS decreased daily pain scores by -73.02% [95% confidence interval (CI) = -95.28 to -52.30] and disability due to pain -43.19 (95%CI, -57.23 to -29.39) at 3 months of follow up. The relative risk for using analgesics was 2.95 (95% CI, 1.36 to 6.30) in the sham group. In the EIMS and sham, the change on the Numerical Pain Scale (NPS0-10) throughout CPM-task was -2.04 (0.79) vs. -0.94 (1.18), respectively, (P = 0.01). EIMS reduced the MEP -28.79 (-53.44 to -4.15), while improved DPMS and intracortical inhibition. The MEP amplitude before treatment [(Beta = -0.61, (-0.58 to -0.26)] and a more significant change from pre- to post-treatment on serum BDNF) (Beta = 0.67; CI95% = 0.07 to 1.26) were predictors to EIMS effect on pain and disability due to pain. Conclusion: These findings suggest that a bottom-up effect induced by the EIMS reduced the analgesic use, improved pain, and disability due to chronic MPS. This effect might be mediated by an enhancing of corticospinal inhibition as seen by an increase in IC and a decrease in MEP amplitude. Likewise, the MEP amplitude before treatment and the changes induced by the EIMS in the serum BDNF predicted it's long-term clinical impact on pain and disability due MPS. The trial is recorded in ClinicalTrials.gov: NCT02381171.
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Affiliation(s)
- Leonardo Botelho
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Anesthesia and Perioperative Pain Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Pain and Palliative Care Service at Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Letícia Angoleri
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Anesthesia and Perioperative Pain Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Maxciel Zortea
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Anesthesia and Perioperative Pain Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Alicia Deitos
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Aline Brietzke
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Iraci L. S. Torres
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Department of Pharmacology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Felipe Fregni
- Spaulding Center of Neuromodulation, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
| | - Wolnei Caumo
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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