Effects of transcranial direct current stimulation block remifentanil-induced hyperalgesia : a randomized, double-blind clinical trial

Detalhes bibliográficos
Autor(a) principal: Braulio, Gilberto
Data de Publicação: 2018
Outros Autores: Passos, Sávio Cavalcante, Leite, Fabrício Moura, Schwertner, André, Stefani, Luciana Paula Cadore, Souza, Ana Cláudia de, Torres, Iraci Lucena da Silva, Fregni, Felipe, Caumo, Wolnei
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da UFRGS
Texto Completo: http://hdl.handle.net/10183/174454
Resumo: Background: Remifentanil-induced hyperalgesia (r-IH) involves an imbalance in the inhibitory and excitatory systems. As the transcranial Direct Current Stimulation (tDCS) modulates the thalamocortical synapses in a top-down manner, we hypothesized that the active (a)-t-DCS would be more effective than sham(s)-tDCS to prevent r-IH. We used an experimental paradigm to induce temporal summation of pain utilizing a repetitive cold test (rCOLDT) assessed by the Numerical Pain Score (NPS 0-10) and we evaluated the function of the descending pain modulatory system (DPMS) by the change on the NPS (0–10) during the conditioned pain modulation (CPM)-task (primary outcomes). We tested whether a-tDCS would be more effective than s-tDCS to improve pain perception assessed by the heat pain threshold (HPT) and the reaction time during the ice-water pain test (IPT) (secondary outcomes). Methods: This double-blinded, factorial randomized trial included 48 healthy males, ages ranging 19–40 years. They were randomized into four equal groups: a-tDCS/saline, s-tDCS/saline, a-tDCS/remifentanil and s-tDCS/remifentanil. tDCS was applied over the primary motor cortex, during 20 min at 2 mA, which was introduced 10 min after starting remifentanil infusion at 0.06 mg kg1 min1 or saline Results: An ANCOVA mixed model revealed that during the rCOLDT, there was a significant main effect on the NPS scores (F = 3.81; P = 0.01). The s-tDCS/remifentanil group presented larger pain scores during rCOLDT, [mean (SD) 5.49 (1.04)] and a-tDCS/remifentanil group had relative lower pain scores [4.15 (1.62)]; showing its blocking effect on r-IH. a-tDCS/saline and s-tDCS/saline groups showed lowest pain scores during rCOLDT, [3.11 (1.2)] and [3.15 (1.62)], respectively. The effect of sedation induced by remifentanil during the rCOLDT was not significant (F = 0.76; P = 0.38). Remifentanil groups showed positive scores in the NPS (0–10) during the CPM-task, that is, it produced a disengagement of the DPMS. Also, s-tDCS/Remifentanil compared to a-tDCS showed lower HPT and larger reaction-time during the IPT. Conclusion: These findings suggest that effects of a-tDCS prevent the summation response induced by r-IH during rCOLDT and the a-tDCS blocked the disengagement of DPMS. Thereby, tDCS could be considered as a new approach to contra-regulate paradoxical mechanisms involved in the r-IH. Clinical trials identification: NCT02432677. URL:https://clinicaltrials.gov/.
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spelling Braulio, GilbertoPassos, Sávio CavalcanteLeite, Fabrício MouraSchwertner, AndréStefani, Luciana Paula CadoreSouza, Ana Cláudia deTorres, Iraci Lucena da SilvaFregni, FelipeCaumo, Wolnei2018-04-05T02:26:11Z20181663-9812http://hdl.handle.net/10183/174454001063175Background: Remifentanil-induced hyperalgesia (r-IH) involves an imbalance in the inhibitory and excitatory systems. As the transcranial Direct Current Stimulation (tDCS) modulates the thalamocortical synapses in a top-down manner, we hypothesized that the active (a)-t-DCS would be more effective than sham(s)-tDCS to prevent r-IH. We used an experimental paradigm to induce temporal summation of pain utilizing a repetitive cold test (rCOLDT) assessed by the Numerical Pain Score (NPS 0-10) and we evaluated the function of the descending pain modulatory system (DPMS) by the change on the NPS (0–10) during the conditioned pain modulation (CPM)-task (primary outcomes). We tested whether a-tDCS would be more effective than s-tDCS to improve pain perception assessed by the heat pain threshold (HPT) and the reaction time during the ice-water pain test (IPT) (secondary outcomes). Methods: This double-blinded, factorial randomized trial included 48 healthy males, ages ranging 19–40 years. They were randomized into four equal groups: a-tDCS/saline, s-tDCS/saline, a-tDCS/remifentanil and s-tDCS/remifentanil. tDCS was applied over the primary motor cortex, during 20 min at 2 mA, which was introduced 10 min after starting remifentanil infusion at 0.06 mg kg1 min1 or saline Results: An ANCOVA mixed model revealed that during the rCOLDT, there was a significant main effect on the NPS scores (F = 3.81; P = 0.01). The s-tDCS/remifentanil group presented larger pain scores during rCOLDT, [mean (SD) 5.49 (1.04)] and a-tDCS/remifentanil group had relative lower pain scores [4.15 (1.62)]; showing its blocking effect on r-IH. a-tDCS/saline and s-tDCS/saline groups showed lowest pain scores during rCOLDT, [3.11 (1.2)] and [3.15 (1.62)], respectively. The effect of sedation induced by remifentanil during the rCOLDT was not significant (F = 0.76; P = 0.38). Remifentanil groups showed positive scores in the NPS (0–10) during the CPM-task, that is, it produced a disengagement of the DPMS. Also, s-tDCS/Remifentanil compared to a-tDCS showed lower HPT and larger reaction-time during the IPT. Conclusion: These findings suggest that effects of a-tDCS prevent the summation response induced by r-IH during rCOLDT and the a-tDCS blocked the disengagement of DPMS. Thereby, tDCS could be considered as a new approach to contra-regulate paradoxical mechanisms involved in the r-IH. Clinical trials identification: NCT02432677. URL:https://clinicaltrials.gov/.application/pdfengFrontiers in Pharmacology. Lausanne. Vol. 9, no. 9 (Feb. 2018), article 94 p. 1-11HiperalgesiaEstimulação transcraniana por corrente contínuatDCSRemifentanilHyperalgesiaPain thresholdCPMEffects of transcranial direct current stimulation block remifentanil-induced hyperalgesia : a randomized, double-blind clinical trialEstrangeiroinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFRGSinstname:Universidade Federal do Rio Grande do Sul (UFRGS)instacron:UFRGSORIGINAL001063175.pdf001063175.pdfTexto completo (inglês)application/pdf1540579http://www.lume.ufrgs.br/bitstream/10183/174454/1/001063175.pdf6b2b411218ee79d9cc94edd6309ebda0MD51TEXT001063175.pdf.txt001063175.pdf.txtExtracted Texttext/plain61605http://www.lume.ufrgs.br/bitstream/10183/174454/2/001063175.pdf.txt22598b95572f9ec62431f5909f08dd64MD52THUMBNAIL001063175.pdf.jpg001063175.pdf.jpgGenerated Thumbnailimage/jpeg1859http://www.lume.ufrgs.br/bitstream/10183/174454/3/001063175.pdf.jpg01ba5248ba4f1f6aa9081d74a584764eMD5310183/1744542022-09-28 04:39:00.989439oai:www.lume.ufrgs.br:10183/174454Repositório de PublicaçõesPUBhttps://lume.ufrgs.br/oai/requestopendoar:2022-09-28T07:39Repositório Institucional da UFRGS - Universidade Federal do Rio Grande do Sul (UFRGS)false
dc.title.pt_BR.fl_str_mv Effects of transcranial direct current stimulation block remifentanil-induced hyperalgesia : a randomized, double-blind clinical trial
title Effects of transcranial direct current stimulation block remifentanil-induced hyperalgesia : a randomized, double-blind clinical trial
spellingShingle Effects of transcranial direct current stimulation block remifentanil-induced hyperalgesia : a randomized, double-blind clinical trial
Braulio, Gilberto
Hiperalgesia
Estimulação transcraniana por corrente contínua
tDCS
Remifentanil
Hyperalgesia
Pain threshold
CPM
title_short Effects of transcranial direct current stimulation block remifentanil-induced hyperalgesia : a randomized, double-blind clinical trial
title_full Effects of transcranial direct current stimulation block remifentanil-induced hyperalgesia : a randomized, double-blind clinical trial
title_fullStr Effects of transcranial direct current stimulation block remifentanil-induced hyperalgesia : a randomized, double-blind clinical trial
title_full_unstemmed Effects of transcranial direct current stimulation block remifentanil-induced hyperalgesia : a randomized, double-blind clinical trial
title_sort Effects of transcranial direct current stimulation block remifentanil-induced hyperalgesia : a randomized, double-blind clinical trial
author Braulio, Gilberto
author_facet Braulio, Gilberto
Passos, Sávio Cavalcante
Leite, Fabrício Moura
Schwertner, André
Stefani, Luciana Paula Cadore
Souza, Ana Cláudia de
Torres, Iraci Lucena da Silva
Fregni, Felipe
Caumo, Wolnei
author_role author
author2 Passos, Sávio Cavalcante
Leite, Fabrício Moura
Schwertner, André
Stefani, Luciana Paula Cadore
Souza, Ana Cláudia de
Torres, Iraci Lucena da Silva
Fregni, Felipe
Caumo, Wolnei
author2_role author
author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Braulio, Gilberto
Passos, Sávio Cavalcante
Leite, Fabrício Moura
Schwertner, André
Stefani, Luciana Paula Cadore
Souza, Ana Cláudia de
Torres, Iraci Lucena da Silva
Fregni, Felipe
Caumo, Wolnei
dc.subject.por.fl_str_mv Hiperalgesia
Estimulação transcraniana por corrente contínua
topic Hiperalgesia
Estimulação transcraniana por corrente contínua
tDCS
Remifentanil
Hyperalgesia
Pain threshold
CPM
dc.subject.eng.fl_str_mv tDCS
Remifentanil
Hyperalgesia
Pain threshold
CPM
description Background: Remifentanil-induced hyperalgesia (r-IH) involves an imbalance in the inhibitory and excitatory systems. As the transcranial Direct Current Stimulation (tDCS) modulates the thalamocortical synapses in a top-down manner, we hypothesized that the active (a)-t-DCS would be more effective than sham(s)-tDCS to prevent r-IH. We used an experimental paradigm to induce temporal summation of pain utilizing a repetitive cold test (rCOLDT) assessed by the Numerical Pain Score (NPS 0-10) and we evaluated the function of the descending pain modulatory system (DPMS) by the change on the NPS (0–10) during the conditioned pain modulation (CPM)-task (primary outcomes). We tested whether a-tDCS would be more effective than s-tDCS to improve pain perception assessed by the heat pain threshold (HPT) and the reaction time during the ice-water pain test (IPT) (secondary outcomes). Methods: This double-blinded, factorial randomized trial included 48 healthy males, ages ranging 19–40 years. They were randomized into four equal groups: a-tDCS/saline, s-tDCS/saline, a-tDCS/remifentanil and s-tDCS/remifentanil. tDCS was applied over the primary motor cortex, during 20 min at 2 mA, which was introduced 10 min after starting remifentanil infusion at 0.06 mg kg1 min1 or saline Results: An ANCOVA mixed model revealed that during the rCOLDT, there was a significant main effect on the NPS scores (F = 3.81; P = 0.01). The s-tDCS/remifentanil group presented larger pain scores during rCOLDT, [mean (SD) 5.49 (1.04)] and a-tDCS/remifentanil group had relative lower pain scores [4.15 (1.62)]; showing its blocking effect on r-IH. a-tDCS/saline and s-tDCS/saline groups showed lowest pain scores during rCOLDT, [3.11 (1.2)] and [3.15 (1.62)], respectively. The effect of sedation induced by remifentanil during the rCOLDT was not significant (F = 0.76; P = 0.38). Remifentanil groups showed positive scores in the NPS (0–10) during the CPM-task, that is, it produced a disengagement of the DPMS. Also, s-tDCS/Remifentanil compared to a-tDCS showed lower HPT and larger reaction-time during the IPT. Conclusion: These findings suggest that effects of a-tDCS prevent the summation response induced by r-IH during rCOLDT and the a-tDCS blocked the disengagement of DPMS. Thereby, tDCS could be considered as a new approach to contra-regulate paradoxical mechanisms involved in the r-IH. Clinical trials identification: NCT02432677. URL:https://clinicaltrials.gov/.
publishDate 2018
dc.date.accessioned.fl_str_mv 2018-04-05T02:26:11Z
dc.date.issued.fl_str_mv 2018
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dc.relation.ispartof.pt_BR.fl_str_mv Frontiers in Pharmacology. Lausanne. Vol. 9, no. 9 (Feb. 2018), article 94 p. 1-11
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