John Glaser1, Scott T Reeves, William David Stoll, Thomas I Epperson, Megan Hilbert, Alok Madan, Mark S George, Jeffrey J Borckardt. 1. *Department of Orthopedic Surgery, Medical University of South Carolina, Charleston, SC †Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC ‡Menninger Clinic and Baylor College of Medicine, Houston, TX §Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC ¶Ralph H. Johnson VAMC, Charleston SC.
Abstract
STUDY DESIGN: Randomized, controlled pilot trial. OBJECTIVE: The present study is the first randomized, double-blind, sham-controlled pilot clinical trial of transcranial direct current stimulation (tDCS) for pain and patient-controlled analgesia (PCA) opioid usage among patients receiving spine surgery. SUMMARY OF BACKGROUND DATA: Lumbar spinal surgeries are common, and while pain is often a complaint that precedes surgical intervention, the procedures themselves are associated with considerable postoperative pain lasting days to weeks. Adequate postoperative pain control is an important factor in determining recovery and new analgesic strategies are needed that can be used adjunctively to existing strategies potentially to reduce reliance on opioid analgesia. Several novel brain stimulation technologies including tDCS are beginning to demonstrate promise as treatments for a variety of pain conditions. METHODS:Twenty-seven patients undergoing lumbar spine procedures at Medical University of South Carolina were randomly assigned to receive four 20-minute sessions of real or sham tDCS during their postsurgical hospital stay. Patient-administered hydromorphone usage was tracked along with numeric rating scale pain ratings. RESULTS: The effect of tDCS on the slope of the cumulative PCA curve was significant (P < 0.001) and tDCS was associated with a 23% reduction in PCA usage. In the real tDCS group a 31% reduction was observed in pain-at-its-least ratings from admission to discharge (P = 0.027), but no other changes in numeric rating scale pain ratings were significant in either group. CONCLUSION: The present pilot trial is the first study to demonstrate an opioid sparing effect of tDCS after spine surgical procedures. Although this was a small pilot trial in a heterogeneous sample of spinal surgery patients, a moderate effect-size was observed for tDCS, suggesting that future work in this area is warranted. LEVEL OF EVIDENCE: 2.
RCT Entities:
STUDY DESIGN: Randomized, controlled pilot trial. OBJECTIVE: The present study is the first randomized, double-blind, sham-controlled pilot clinical trial of transcranial direct current stimulation (tDCS) for pain and patient-controlled analgesia (PCA) opioid usage among patients receiving spine surgery. SUMMARY OF BACKGROUND DATA: Lumbar spinal surgeries are common, and while pain is often a complaint that precedes surgical intervention, the procedures themselves are associated with considerable postoperative pain lasting days to weeks. Adequate postoperative pain control is an important factor in determining recovery and new analgesic strategies are needed that can be used adjunctively to existing strategies potentially to reduce reliance on opioid analgesia. Several novel brain stimulation technologies including tDCS are beginning to demonstrate promise as treatments for a variety of pain conditions. METHODS: Twenty-seven patients undergoing lumbar spine procedures at Medical University of South Carolina were randomly assigned to receive four 20-minute sessions of real or sham tDCS during their postsurgical hospital stay. Patient-administered hydromorphone usage was tracked along with numeric rating scale pain ratings. RESULTS: The effect of tDCS on the slope of the cumulative PCA curve was significant (P < 0.001) and tDCS was associated with a 23% reduction in PCA usage. In the real tDCS group a 31% reduction was observed in pain-at-its-least ratings from admission to discharge (P = 0.027), but no other changes in numeric rating scale pain ratings were significant in either group. CONCLUSION: The present pilot trial is the first study to demonstrate an opioid sparing effect of tDCS after spine surgical procedures. Although this was a small pilot trial in a heterogeneous sample of spinal surgery patients, a moderate effect-size was observed for tDCS, suggesting that future work in this area is warranted. LEVEL OF EVIDENCE: 2.
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: Nemanja Rancic; Katarina Mladenovic; Nela V Ilic; Viktorija Dragojevic-Simic; Menelaos Karanikolas; Tihomir V Ilic; Dusica M Stamenkovic Journal: Int J Environ Res Public Health Date: 2020-01-28 Impact factor: 3.390
Authors: M A Day; D M Ehde; J Burns; L C Ward; J L Friedly; B E Thorn; M A Ciol; E Mendoza; J F Chan; S Battalio; J Borckardt; M P Jensen Journal: Contemp Clin Trials Date: 2020-04-14 Impact factor: 2.226