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Gunduz ME, Pacheco-Barrios K, Bonin Pinto C, Duarte D, Vélez FGS, Gianlorenco ACL, Teixeira PEP, Giannoni-Luza S, Crandell D, Battistella LR, Simis M, Fregni F. Effects of Combined and Alone Transcranial Motor Cortex Stimulation and Mirror Therapy in Phantom Limb Pain: A Randomized Factorial Trial. Neurorehabil Neural Repair 2021; 35:704-716. [PMID: 34060934 PMCID: PMC10042175 DOI: 10.1177/15459683211017509] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Phantom limb pain (PLP) is a frequent complication in amputees, which is often refractory to treatments. We aim to assess in a factorial trial the effects of transcranial direct current stimulation (tDCS) and mirror therapy (MT) in patients with traumatic lower limb amputation; and whether the motor cortex plasticity changes drive these results. In this large randomized, blinded, 2-site, sham-controlled, 2 × 2 factorial trial, 112 participants with traumatic lower limb amputation were randomized into treatment groups. The interventions were active or covered MT for 4 weeks (20 sessions, 15 minutes each) combined with 2 weeks of either active or sham tDCS (10 sessions, 20 minutes each) applied to the contralateral primary motor cortex. The primary outcome was PLP changes on the visual analogue scale at the end of interventions (4 weeks). Motor cortex excitability and cortical mapping were assessed by transcranial magnetic stimulation (TMS). We found no interaction between tDCS and MT groups (F = 1.90, P = .13). In the adjusted models, there was a main effect of active tDCS compared to sham tDCS (beta coefficient = -0.99, P = .04) on phantom pain. The overall effect size was 1.19 (95% confidence interval: 0.90, 1.47). No changes in depression and anxiety were found. TDCS intervention was associated with increased intracortical inhibition (coefficient = 0.96, P = .02) and facilitation (coefficient = 2.03, P = .03) as well as a posterolateral shift of the center of gravity in the affected hemisphere. MT induced no motor cortex plasticity changes assessed by TMS. These findings indicate that transcranial motor cortex stimulation might be an affordable and beneficial PLP treatment modality.
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Affiliation(s)
- Muhammed Enes Gunduz
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kevin Pacheco-Barrios
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Universidad San Ignacio de Loyola, Lima, Peru
| | - Camila Bonin Pinto
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Northwestern University, Chicago, IL, USA
| | - Dante Duarte
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,McMaster University, Hamilton, Ontario, Canada
| | - Faddi Ghassan Saleh Vélez
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,University of Chicago Medical Center, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Anna Carolyna Lepesteur Gianlorenco
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Paulo Eduardo Portes Teixeira
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Stefano Giannoni-Luza
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David Crandell
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Felipe Fregni
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Li L, Pan Q, Xu L, Lin R, Dai J, Chen X, Jiang M, Chen Z. Comparison of analgesic and anxiolytic effects of nitrous oxide in burn wound treatment: A single-blind prospective randomized controlled trial. Medicine (Baltimore) 2019; 98:e18188. [PMID: 31860965 PMCID: PMC6940169 DOI: 10.1097/md.0000000000018188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AIM We compared the effects of 50% N2O and N2O titration in burn management to alleviate pain and anxiety associated with burn dressing. METHODS In this single-blind prospective randomized controlled trial, 70 stable adult burn patients were randomized to 2 groups during May 2015 to January 2016. The experimental group was titrated with N2O ranging from 30% to the ideal sedation concentration before dressing change until the end. The control group was treated with 50% N2O 2 minutes before dressing change until the end. Pain, anxiety, vital signs, and the highest concentrations of N2O inhaled were recorded at 1 minute before N2O inhalation (T0), dismantling of outer (T1), inner dressings (T2), debridement (T3), drug-smearing (T4), bandaging (T5), and 10 minutes after completion of the procedure (T6). RESULTS The pain and anxiety scores in the experimental group performed significantly less than the control group during T2-T6. The systolic blood pressure in T2 and the heart rate at T2 and T3 varied significantly between the 2 groups. The highest N2O concentrations of the experimental group were mainly 60% to 70% at T2 (87.9%), T3 (87.9%), and T4 (81.8%). CONCLUSION N2O titration significantly reduced pain and anxiety in burn patients, with minimal side effects.
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Affiliation(s)
| | - Qiong Pan
- Department of Nursing, Fujian Medical University Union Hospital
| | - Le Xu
- Department of Nursing, Fujian Medical University Union Hospital
| | - Renqin Lin
- Fujian Medical University Union Clinical Medical Institute, Fuzhou, Fujian Province, China
| | - Jiaxi Dai
- Fujian Medical University Union Clinical Medical Institute, Fuzhou, Fujian Province, China
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Oh J, Sohn JH, Shin CS, Na SH, Yoon HJ, Kim JJ, Park S, Park JY. Mutual relationship between anxiety and pain in the intensive care unit and its effect on medications. J Crit Care 2015; 30:1043-8. [PMID: 26116140 DOI: 10.1016/j.jcrc.2015.05.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 05/19/2015] [Accepted: 05/20/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE Little is known about the relationship between anxiety and pain in intensive care unit (ICU) patients despite its importance. The aims of the present study are to examine the correlation between pain and anxiety during ICU care and to investigate its effects on the dose of opioids and anxiolytics administered. METHODS The study subjects were awake critically ill patients admitted to an ICU over a 2-month period. Trained psychiatrists evaluated the nondelirious, noncomatose patients daily for anxiety and pain using the Numeric Rating Scale for Pain (NRS-Pain), Faces Anxiety Scale (FAS), and Hamilton Anxiety Rating Scale. RESULTS Daily alterations of anxiety and pain were significantly correlated with one another among 123 patients. Both the FAS and the Hamilton Anxiety Rating Scale were positively correlated with the NRS-Pain (P < .001 for both). The NRS-Pain score (P = .016) and the FAS score (P = .007) both significantly correlated with the dose of anxiolytics. The dose of opioids was unaffected by the severity of pain or anxiety. CONCLUSIONS Pain and anxiety among critically ill patients in the ICU were closely correlated. Pain and anxiety influenced the dose of anxiolytics administered. Therefore, a precise evaluation and comprehensive approach to the management of pain and anxiety are important for treating ICU patients.
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Affiliation(s)
- Jooyoung Oh
- Department of Psychiatry and Institute of Behavioral Science in Medicine, College of Medicine, Yonsei University, Gangnam Severance Hospital, Seoul, South Korea; Department of Medical System Engineering (DMSE), Gwangju Institute of Science and Technology (GIST), Gwangju, South Korea
| | - Jeong-Hyun Sohn
- Department of Psychiatry and Institute of Behavioral Science in Medicine, College of Medicine, Yonsei University, Gangnam Severance Hospital, Seoul, South Korea
| | - Cheung Soo Shin
- Department of Anesthesiology, College of Medicine, Yonsei University, Seoul, South Korea
| | - Se Hee Na
- Department of Anesthesiology, College of Medicine, Yonsei University, Seoul, South Korea
| | - Hyung-Jun Yoon
- Department of Psychiatry, Glory Hospital, Incheon, South Korea
| | - Jae-Jin Kim
- Department of Psychiatry and Institute of Behavioral Science in Medicine, College of Medicine, Yonsei University, Gangnam Severance Hospital, Seoul, South Korea
| | - Sunyoung Park
- Department of Psychiatry and Institute of Behavioral Science in Medicine, College of Medicine, Yonsei University, Gangnam Severance Hospital, Seoul, South Korea
| | - Jin Young Park
- Department of Psychiatry and Institute of Behavioral Science in Medicine, College of Medicine, Yonsei University, Gangnam Severance Hospital, Seoul, South Korea.
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