BACKGROUND: Although pain is often a symptom that precedes total knee arthroplasty (TKA), the procedure itself is associated with considerable postoperative pain lasting days to weeks. Postoperative pain control is an important factor in determining recovery time, hospital length of stay, and rehabilitation success. Several brain stimulation technologies including transcranial direct current stimulation (tDCS) have demonstrated promise as treatments for a variety of pain conditions. The present study examined the effects of 4 sessions of tDCS on post-TKA pain and opioid consumption. MATERIALS AND METHODS:Forty patients undergoing unilateral TKA were randomly assigned to receive a total of 80 minutes of real (n=20) or sham tDCS (n=20) with the anode over the knee representation of the motor strip (C1h or C2h corresponding to the target knee) and cathode over the right dorsolateral prefrontal cortex (F3; located by the EEG 10-20 System). Patient-controlled analgesia ( hydromorphone) use was tracked during the ∼48 hours postsurgery. RESULTS: Patients in the real tDCS group used an average of 6.6 mg (SD=5.3) of patient-controlled analgesia hydromorphone, whereas those in the sham group used 12.3 mg (SD=6.6; t37=2.93, P=0.006). Despite using less opioid medication, participants in the real tDCS group reported no pain exacerbation or worse mood with respect to those in the sham tDCS group. CONCLUSIONS: Results from this pilot feasibility study suggest that tDCS may be able to reduce post-TKA opioid requirements. Although these results are preliminary, the data support further research in the area of adjunctive cortical stimulation in the management of postsurgical pain.
RCT Entities:
BACKGROUND: Although pain is often a symptom that precedes total knee arthroplasty (TKA), the procedure itself is associated with considerable postoperative pain lasting days to weeks. Postoperative pain control is an important factor in determining recovery time, hospital length of stay, and rehabilitation success. Several brain stimulation technologies including transcranial direct current stimulation (tDCS) have demonstrated promise as treatments for a variety of pain conditions. The present study examined the effects of 4 sessions of tDCS on post-TKA pain and opioid consumption. MATERIALS AND METHODS: Forty patients undergoing unilateral TKA were randomly assigned to receive a total of 80 minutes of real (n=20) or sham tDCS (n=20) with the anode over the knee representation of the motor strip (C1h or C2h corresponding to the target knee) and cathode over the right dorsolateral prefrontal cortex (F3; located by the EEG 10-20 System). Patient-controlled analgesia ( hydromorphone) use was tracked during the ∼48 hours postsurgery. RESULTS:Patients in the real tDCS group used an average of 6.6 mg (SD=5.3) of patient-controlled analgesia hydromorphone, whereas those in the sham group used 12.3 mg (SD=6.6; t37=2.93, P=0.006). Despite using less opioid medication, participants in the real tDCS group reported no pain exacerbation or worse mood with respect to those in the sham tDCS group. CONCLUSIONS: Results from this pilot feasibility study suggest that tDCS may be able to reduce post-TKA opioid requirements. Although these results are preliminary, the data support further research in the area of adjunctive cortical stimulation in the management of postsurgical pain.
Authors: Jeffrey J Borckardt; Scott T Reeves; Cole Milliken; Brittan Carter; Thomas I Epperson; Ryan J Gunselman; Alok Madan; H Del Schutte; Harry A Demos; Mark S George Journal: Brain Stimul Date: 2017-09-06 Impact factor: 8.955
Authors: Hamed Ekhtiari; Hosna Tavakoli; Giovanni Addolorato; Chris Baeken; Antonello Bonci; Salvatore Campanella; Luis Castelo-Branco; Gaëlle Challet-Bouju; Vincent P Clark; Eric Claus; Pinhas N Dannon; Alessandra Del Felice; Tess den Uyl; Marco Diana; Massimo di Giannantonio; John R Fedota; Paul Fitzgerald; Luigi Gallimberti; Marie Grall-Bronnec; Sarah C Herremans; Martin J Herrmann; Asif Jamil; Eman Khedr; Christos Kouimtsidis; Karolina Kozak; Evgeny Krupitsky; Claus Lamm; William V Lechner; Graziella Madeo; Nastaran Malmir; Giovanni Martinotti; William M McDonald; Chiara Montemitro; Ester M Nakamura-Palacios; Mohammad Nasehi; Xavier Noël; Masoud Nosratabadi; Martin Paulus; Mauro Pettorruso; Basant Pradhan; Samir K Praharaj; Haley Rafferty; Gregory Sahlem; Betty Jo Salmeron; Anne Sauvaget; Renée S Schluter; Carmen Sergiou; Alireza Shahbabaie; Christine Sheffer; Primavera A Spagnolo; Vaughn R Steele; Ti-Fei Yuan; Josanne D M van Dongen; Vincent Van Waes; Ganesan Venkatasubramanian; Antonio Verdejo-García; Ilse Verveer; Justine W Welsh; Michael J Wesley; Katie Witkiewitz; Fatemeh Yavari; Mohammad-Reza Zarrindast; Laurie Zawertailo; Xiaochu Zhang; Yoon-Hee Cha; Tony P George; Flavio Frohlich; Anna E Goudriaan; Shirley Fecteau; Stacey B Daughters; Elliot A Stein; Felipe Fregni; Michael A Nitsche; Abraham Zangen; Marom Bikson; Colleen A Hanlon Journal: Neurosci Biobehav Rev Date: 2019-07-02 Impact factor: 8.989
Authors: F Fregni; M A Nitsche; C K Loo; A R Brunoni; P Marangolo; J Leite; S Carvalho; N Bolognini; W Caumo; N J Paik; M Simis; K Ueda; H Ekhitari; P Luu; D M Tucker; W J Tyler; J Brunelin; A Datta; C H Juan; G Venkatasubramanian; P S Boggio; M Bikson Journal: Clin Res Regul Aff Date: 2015-03-01
Authors: Dario Tedesco; Davide Gori; Karishma R Desai; Steven Asch; Ian R Carroll; Catherine Curtin; Kathryn M McDonald; Maria P Fantini; Tina Hernandez-Boussard Journal: JAMA Surg Date: 2017-10-18 Impact factor: 14.766
Authors: Aleksandra Vuckovic; Muhammad A Hasan; Matthew Fraser; Bernard A Conway; Bahman Nasseroleslami; David B Allan Journal: J Pain Date: 2014-03-01 Impact factor: 5.820