Transcranial direct current stimulation associated to multidisciplinary treatment for fibromyalgia: a double-blinded, randomized controlled trial / Estimulação transcraniana com corrente contínua associada ao tratamento multidisciplinar da fibromialgia: um estudo duplo-cego, aleatorizado e controlado

AUTOR(ES)
DATA DE PUBLICAÇÃO

2008

RESUMO

Transcranial direct current stimulation (tDCS) is a non-invasive technique of cortical brain stimulation which has shown some positive effects on chronic pain control. The main hypothesis of this study was to verify if the association of tDCS to the multidisciplinary approach in patients with fibromyalgia would increase the results for the control of pain and improve quality of life. The study design was a randomized, double-blinded, shamcontrolled clinical Trial of parallel arms. Twenty tree women with fibromyalgia received the usual treatment with the multidisciplinary approach and drugs, and were randomly allocated in a group with 2mA anodic tDCS for 20 minutes over the left primary motor cortex and the cathode was positioned over the right supra-orbital region. Another group with sham stimulation, with the same electrode positioning, had the electric current interrupted within 1 minute from of stimulation and remained off during the remaining 19 minutes. Stimulations occurred weekly for 10 weeks, always before the multidisciplinary intervention. Pain was rated at the begging of the treatment and after its end by the visual analogue scale (VAS) e pressure dolorimetry on fibromyalgia tender points. Quality of life was evaluated with the Fibromyalgia impact questionnaire (FIQ) and SF-36. As possible confounders, humor and functional capacity were evaluated with Beck depression index (BDI), Hamilton scale (HAM) and HAQ. There were no serious adverse effects. There was a significant improvement in the Pain domain of SF-36, with significant effect only in the group under active tDCS (from 26.6 ± 12.9 to 45.6 ± 15.1 in the end of the treatment, p=0.006). Any of the other outcomes showed statistically significant improvement, except for FIQ, which presented with a marginally significant improvement in the active group (62.1 ± 11.5 to 49.2 ± 21.2; p=0.056) and HAQ (1.51 ± 0.47 to 1.24 ± 0.4; p=0.0005), without any difference in both groups. These results partially reproduce previous findings of pain improvement with non-invasive stimulation of the motor cortex, however with smaller effects, maybe due to the use of a reduced weekly frequency of stimuli. The lack of differential gains in the active group in other dimensions of functioning suggests the used stimulation be specifically effective for pain. The conclusion is that the association of tDCS to the multidisciplinary approach may bring additional improvement in the control of pain in fibromyalgia

ASSUNTO(S)

comprehensive health care neurophysiology/instrumentation fibromyalgia/rehabilitation dor/reabilitação qualidade de vida assistência integral a saúde fibromialgia/reabilitação terapia por estimulação elétrica/tendências electric stimulation therapy/tendencies pain/rehabilitation neurofisiologia/instrumentação quality of life

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