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Moro MZ, de Oliveira Vidal EI, Pinheiro Módolo NS, Bono Fukushima F, Moreira de Barros GA. Dry needling, trigger point electroacupuncture and motor point electroacupuncture for the treatment of myofascial pain syndrome involving the trapezius: a randomised clinical trial. Acupunct Med 2024; 42:3-13. [PMID: 37905789 DOI: 10.1177/09645284231207865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
OBJECTIVE The objective of this study was to compare trigger point (TrP) dry needling, TrP electroacupuncture and motor point electroacupuncture of the trapezius muscle for the treatment of myofascial pain syndrome (MPS). METHODS This randomised clinical trial included 90 patients divided into three groups. Group 1 was treated with dry needling of TrPs, group 2 with intramuscular electrical stimulation of TrPs, and group 3 with electroacupuncture of motor points and/or the spinal accessory nerve. Each group received seven treatment sessions. The outcomes were the pain score measured by visual analogue scale (VAS) and quality of life evaluated by the 12-item short form (SF-12) health questionnaire. We compared the pain outcome over serial time points using growth curve analysis methods. RESULTS Participants in the three groups experienced significant improvements in pain scores over time. The average pain level of participants in group 3 across the repeated assessments was 0.98 units lower than in group 1 (mean difference (95% confidence interval (CI) = 1.74-0.23)), p = 0.012). There were no significant differences in pain scores between participants in groups 1 and 2, and there were no significant differences in quality of life across the three groups at the end of the treatment period. CONCLUSION Our results provide evidence that electrical stimulation of motor points and/or of the spinal accessory nerve may be superior in terms of pain relief (but not quality of life) to dry needling and possibly electrical stimulation of trigger points for the management of MPS involving the trapezius. TRIAL REGISTRATION NUMBER TRIAL-RBR-43R7RF (Brazilian Clinical Trials Registry).
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Affiliation(s)
- Marlene Zuccolotto Moro
- Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University (Unesp), Botucatu, Brazil
| | - Edison Iglesias de Oliveira Vidal
- Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University (Unesp), Botucatu, Brazil
| | - Norma Sueli Pinheiro Módolo
- Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University (Unesp), Botucatu, Brazil
| | - Fernanda Bono Fukushima
- Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University (Unesp), Botucatu, Brazil
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da Silva RDMF, Brunoni AR, Miguel EC, Shavitt RG. Transcranial direct current stimulation for treatment-resistant obsessive-compulsive disorder: report on two cases and proposal for a randomized, sham-controlled trial. SAO PAULO MED J 2016; 134:446-450. [PMID: 27901245 PMCID: PMC10871858 DOI: 10.1590/1516-3180.2016.0155010716] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 01/10/2023] Open
Abstract
CONTEXT AND OBJECTIVE Neuromodulation techniques for treating obsessive-compulsive disorder (OCD) have expanded through greater understanding of the brain circuits involved in this disorder. Transcranial direct current stimulation (tDCS), a non-invasive technique, has been studied as an alternative for treatment-resistant OCD. We describe the design of a clinical trial using tDCS for OCD and report on the outcomes from two patients with primary OCD who were resistant to cognitive-behavioral therapy and to selective serotonin reuptake inhibitors, and who received tDCS in an open manner during the training phase for the study procedures. DESIGN AND SETTING Methodological description of a clinical trial using tDCS for treatment-resistant OCD at a university hospital; and a report on two cases. METHODS The proposed study is randomized, sham-controlled and double-blind. Forty-four patients will be randomized to either active or sham intervention. The active intervention consists of applying an electric current of 2 mA, with the cathode positioned in the region corresponding to the supplementary motor cortex (bilaterally) and the anode positioned in the deltoid. The primary outcome will be the reduction in baseline YBOCS (Yale-Brown Obsessive Compulsive Scale) score at the end of week 4. The secondary outcomes will be depression and anxiety symptoms. Genetic markers, cortical excitability and neurocognitive performance will be investigated. RESULTS The first patient showed significant improvement, whereas the second remained symptomatic after four weeks and after six months. tDCS was well tolerated. CONCLUSION tDCS for treatment-resistant OCD merits randomized controlled trials that test its effectiveness.
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Affiliation(s)
- Renata de Melo Felipe da Silva
- MD. Doctoral Student, Obsessive-Compulsive Spectrum Disorders Program, Department and Institute of Psychiatry, Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP, Brazil.
| | - André Russowsky Brunoni
- MD, PhD. Director, Service of Interdisciplinary Neuromodulation (SIN), Department and Institute of Psychiatry, Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP, Brazil.
| | - Eurípedes Constantino Miguel
- MD, PhD. Full Professor of Psychiatry, Obsessive-Compulsive Spectrum Disorders Program, Department and Institute of Psychiatry, Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP, Brazil.
| | - Roseli Gedanke Shavitt
- MD, PhD. Director, Obsessive-Compulsive Spectrum Disorders Program, Department and Institute of Psychiatry, Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP, Brazil.
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Brunoni AR, Sampaio-Junior B, Moffa AH, Borrione L, Nogueira BS, Aparício LVM, Veronezi B, Moreno M, Fernandes RA, Tavares D, Bueno PVS, Seibt O, Bikson M, Fraguas R, Benseñor IM. The Escitalopram versus Electric Current Therapy for Treating Depression Clinical Study (ELECT-TDCS): rationale and study design of a non-inferiority, triple-arm, placebo-controlled clinical trial. SAO PAULO MED J 2015; 133:252-63. [PMID: 26176930 PMCID: PMC10876376 DOI: 10.1590/1516-3180.2014.00351712] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 11/24/2014] [Accepted: 12/17/2014] [Indexed: 12/28/2022] Open
Abstract
CONTEXT AND OBJECTIVE Major depressive disorder (MDD) is a common psychiatric condition, mostly treated with antidepressant drugs, which are limited due to refractoriness and adverse effects. We describe the study rationale and design of ELECT-TDCS (Escitalopram versus Electric Current Therapy for Treating Depression Clinical Study), which is investigating a non-pharmacological treatment known as transcranial direct current stimulation (tDCS). DESIGN AND SETTING Phase-III, randomized, non-inferiority, triple-arm, placebo-controlled study, ongoing in São Paulo, Brazil. METHODS ELECT-TDCS compares the efficacy of active tDCS/placebo pill, sham tDCS/escitalopram 20 mg/day and sham tDCS/placebo pill, for ten weeks, randomizing 240 patients in a 3:3:2 ratio, respectively. Our primary aim is to show that tDCS is not inferior to escitalopram with a non-inferiority margin of at least 50% of the escitalopram effect, in relation to placebo. As secondary aims, we investigate several biomarkers such as genetic polymorphisms, neurotrophin serum markers, motor cortical excitability, heart rate variability and neuroimaging. RESULTS Proving that tDCS is similarly effective to antidepressants would have a tremendous impact on clinical psychiatry, since tDCS is virtually devoid of adverse effects. Its ease of use, portability and low price are further compelling characteristics for its use in primary and secondary healthcare. Multimodal investigation of biomarkers will also contribute towards understanding the antidepressant mechanisms of action of tDCS. CONCLUSION Our results have the potential to introduce a novel technique to the therapeutic arsenal of treatments for depression.
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Affiliation(s)
- André Russowsky Brunoni
- MD, PhD. Attending Physician, Interdisciplinary Neuromodulation Service, Interdisciplinary Center for Applied Neuromodulation, Hospital Universitário (HU), and Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Universidade de São Paulo (USP), São Paulo, Brazil.
| | - Bernardo Sampaio-Junior
- MD. Interdisciplinary Neuromodulation Service, Interdisciplinary Center for Applied Neuromodulation, HU, and Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, USP, São Paulo, Brazil.
| | - Adriano Henrique Moffa
- BA, MSc. Interdisciplinary Center for Applied Neuromodulation, HU, USP, São Paulo, Brazil.
| | - Lucas Borrione
- MD, MSc. Interdisciplinary Center for Applied Neuromodulation, HU and Department and Institute of Psychiatry, USP, São Paulo, Brazil.
| | | | | | - Beatriz Veronezi
- Psychology Student, Interdisciplinary Center for Applied Neuromodulation, HU, USP, São Paulo, Brazil.
| | - Marina Moreno
- Psychology Student, Interdisciplinary Center for Applied Neuromodulation, HU, USP, São Paulo, Brazil.
| | - Raquel Albano Fernandes
- Psychology Student, Interdisciplinary Center for Applied Neuromodulation, HU, USP, São Paulo, Brazil.
| | - Diego Tavares
- MD. Medical Resident and Student, Interdisciplinary Neuromodulation Service, Interdisciplinary Center for Applied Neuromodulation, HU and Department and Institute of Psychiatry, USP, São Paulo, Brazil.
| | - Priscila Vilela Silveira Bueno
- MD. Medical Resident and Student, Interdisciplinary Neuromodulation Service, Interdisciplinary Center for Applied Neuromodulation, HU and Department and Institute of Psychiatry, USP, São Paulo, Brazil.
| | - Ole Seibt
- MSc. Researcher, Department of Biomedical Engineering, City College of City University of New York, New York, USA.
| | - Marom Bikson
- PhD. Head, Department of Biomedical Engineering, City College of City University of New York, New York, USA.
| | - Renerio Fraguas
- MD, PhD. Assistant Professor, HU and Department and Institute of Psychiatry, USP, São Paulo, Brazil.
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Imoto AM, Peccin MS, Teixeira LEPDP, Silva KNGD, Abrahão M, Trevisani VFM. Is neuromuscular electrical stimulation effective for improving pain, function and activities of daily living of knee osteoarthritis patients? A randomized clinical trial. SAO PAULO MED J 2013; 131:80-7. [PMID: 23657509 PMCID: PMC10871721 DOI: 10.1590/s1516-31802013000100017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 11/15/2011] [Accepted: 07/02/2012] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Neuromuscular electrical stimulation (NMES) has been used in rehabilitation protocols for patients suffering from muscle weakness resulting from knee osteoarthritis. The purpose of the present study was to assess the effectiveness of an eight-week treatment program of NMES combined with exercises, for improving pain and function among patients with knee osteoarthritis. DESIGN AND SETTING Randomized clinical trial at Interlagos Specialty Ambulatory Clinic, Sao Paulo, Brazil. METHODS One hundred were randomized into two groups: NMES group and control group. The following evaluation measurements were used: numerical pain scale from 0 to 10, timed up and go (TUG) test, Lequesne index and activities of daily living (ADL) scale. RESULTS Eighty-two patients completed the study. From intention-to-treat (ITT) analysis comparing the groups, the NMES group showed a statistically significant improvement in relation to the control group, regarding pain intensity (difference between means: 1.67 [0.31 to 3.02]; P = 0.01), Lequesne index (difference between means: 1.98 [0.15 to 3.79]; P = 0.03) and ADL scale (difference between means: -11.23 [-19.88 to -2.57]; P = 0.01). CONCLUSION NMES, within a rehabilitation protocol for patients with knee osteoarthritis, is effective for improving pain, function and activities of daily living, in comparison with a group that received an orientation program. CLINICAL TRIAL REGISTRATION ACTRN012607000357459.
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Imoto AM, Peccin S, Almeida GJM, Saconato H, Atallah ÁN. Effectiveness of electrical stimulation on rehabilitation after ligament and meniscal injuries: a systematic review. SAO PAULO MED J 2011; 129:414-23. [PMID: 22249798 PMCID: PMC10868930 DOI: 10.1590/s1516-31802011000600008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 05/09/2011] [Accepted: 05/23/2011] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Electrical stimulation (ES) is widely used to strengthen muscles following ligament and meniscal injuries. The aim of this study was to evaluate the effectiveness of ES for rehabilitation after soft tissue injuries of the knee treated surgically or conservatively. DESIGN AND SETTING Systematic review at the Brazilian Cochrane Center. METHODS We searched the Cochrane Central Register of Controlled Trials (2010, Issue 12), Medline (Medical Analysis and Retrieval System Online) via PubMed (1966 to December 2010), Embase (Excerpta Medica database, 1980 to December 2010), Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde, 1982 to December 2010), and PEDro (Physiotherapy Evidence Database, 1929 to December 2010). The studies included were randomized controlled trials using ES to increase muscle strength for rehabilitation of patients with soft tissue injuries of the knee. Two authors independently evaluated studies for inclusion and performed data extraction and methodological quality assessment. RESULTS Seventeen studies evaluating ES after anterior cruciate ligament reconstruction and two studies evaluating ES after meniscectomy were included. There was a statistically significant improvement in quadriceps strength through ES (mean difference, MD: -32.7; 95% confidence interval, CI: -39.92 to -25.48; n = 56) and in functional outcomes (MD -7; -12.78 to -1.22; n = 43) six to eight weeks after surgical reconstruction of the anterior cruciate ligament. CONCLUSION There is evidence that ES coupled with conventional rehabilitation exercises may be effective in improving muscle strength and function two months after surgery.
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Affiliation(s)
- Aline Mizusaki Imoto
- PhD. Postgraduate Program on Internal Medicine and Therapeutics, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
| | - Stella Peccin
- PhD. Supervising Professor of the Postgraduate Program on Internal Medicine and Therapeutics, Universidade Federal de São Paulo (Unifesp), São Paulo; and Head of the Department of Movement Sciences, Universidade Federal de São Paulo, Campus Baixada Santista, São Paulo, Brazil.
| | | | - Humberto Saconato
- PhD, Adjunct Professor, Department of Clinical Medicine, Universidade Federal do Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil.
| | - Álvaro Nagib Atallah
- PhD. Titular Professor, Department of Internal Medicine, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
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