Effects of transcranial direct current stimulation block remifentanil-induced hyperalgesia : a randomized, double-blind clinical trial
Autor(a) principal: | |
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Data de Publicação: | 2018 |
Outros Autores: | , , , , , , , |
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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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 |
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2018 |
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Estrangeiro info:eu-repo/semantics/article |
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info:eu-repo/semantics/publishedVersion |
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status_str |
publishedVersion |
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http://hdl.handle.net/10183/174454 |
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1663-9812 |
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001063175 |
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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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