PMID- 29190741
OWN - NLM
STAT- MEDLINE
DCOM- 20171226
LR  - 20220331
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 12
IP  - 11
DP  - 2017
TI  - Preoperative transcranial direct current stimulation: Exploration of a novel 
      strategy to enhance neuroplasticity before surgery to control postoperative pain. 
      A randomized sham-controlled study.
PG  - e0187013
LID - 10.1371/journal.pone.0187013 [doi]
LID - e0187013
AB  - BACKGROUND: An imbalance in the excitatory/inhibitory systems in the pain 
      networks may explain the persistent chronic pain after hallux valgus surgery. 
      Thus, to contra-regulate this dysfunction, the use of transcranial direct current 
      stimulation (tDCS) becomes attractive. OBJECTIVE: We tested the hypothesis that 
      two preoperative active(a)-tDCS sessions compared with sham(s)-tDCS could improve 
      the postoperative pain [as indexed by Visual Analogue Scale (VAS) at rest and 
      during walking (primary outcomes)]. To assess their effect on the change in the 
      Numerical Pain Scale (NPS0-10) during Conditioned Pain Modulation (CPM-task), 
      disability related to pain (DRP) and analgesic consumption (secondary outcomes). 
      Also, we assessed if the brain derived neurotrophic factor (BDNF) in the cerebral 
      spinal fluid (CSF) after tDCS could predict the intervention's effect on the DRP. 
      METHODS: It is a prospective, double blind, sham-controlled, randomized single 
      center, 40 women (18-70 years-old) who had undergone hallux valgus surgery were 
      randomized to receive two sessions (20 minutes each) of anodal a-tDCS or s-tDCS 
      on the primary motor cortex at night and in the morning before the surgery. To 
      assess the DRP was used the Brazilian Profile of Chronic Pain: Screen (B-PCP:S). 
      RESULTS: A-tDCS group showed lower scores on VAS at rest and during walking 
      (P<0.001). At rest, the difference between groups was 2.13cm (95%CI = 1.59 to 
      2.68) while during walking was 1.67cm (95%CI = 1.05 to 2.28). A-tDCS, when 
      compared to s-tDCS reduced analgesic doses in 73.25% (P<0.001), produced a 
      greater reduction in B-PCP:S (mean difference of 9.41 points, 95%CI = 0.63 to 
      18.21) and higher function of descending pain modulatory system (DPMS) during 
      CPM-task. CONCLUSION: A-tDCS improves postoperative pain, the DRP and the 
      function of DPMS. Also, the CSF BDNF after a-tDCS predicted the improvement in 
      the DRP. In overall, these findings suggest that a-tDCS effects may be mediated 
      by top-down regulatory mechanisms associated with the inhibitory cortical 
      control. TRIAL REGISTRATION: ClinicalTrials.gov NCT02360462.
FAU - Ribeiro, Hugo
AU  - Ribeiro H
AD  - Department of Clinical Research Center, Laboratory of Pain & Neuromodulation, 
      Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, 
      Porto Alegre, Rio Grande do Sul, Brazil.
AD  - Surgery Department, Hospital Independencia, Porto Alegre, Rio Grande do Sul, 
      Brazil.
FAU - Sesterhenn, Ricardo Bertol
AU  - Sesterhenn RB
AD  - Surgery Department, Hospital Independencia, Porto Alegre, Rio Grande do Sul, 
      Brazil.
FAU - Souza, Andressa de
AU  - Souza A
AD  - Department of Clinical Research Center, Laboratory of Pain & Neuromodulation, 
      Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, 
      Porto Alegre, Rio Grande do Sul, Brazil.
FAU - Souza, Ana Claudia de
AU  - Souza AC
AD  - Department of Clinical Research Center, Laboratory of Pain & Neuromodulation, 
      Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, 
      Porto Alegre, Rio Grande do Sul, Brazil.
FAU - Alves, Monique
AU  - Alves M
AD  - Surgery Department, Hospital Independencia, Porto Alegre, Rio Grande do Sul, 
      Brazil.
FAU - Machado, Jessica Catarina
AU  - Machado JC
AD  - Postgraduate Program in Health and Human Development, La Salle University Center, 
      Canoas, Rio Grande do Sul, Brazil.
FAU - Burger, Nathalia Bofill
AU  - Burger NB
AD  - Surgery Department, Hospital Independencia, Porto Alegre, Rio Grande do Sul, 
      Brazil.
FAU - Torres, Iraci Lucena da Silva
AU  - Torres ILDS
AD  - Department of Clinical Research Center, Laboratory of Pain & Neuromodulation, 
      Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, 
      Porto Alegre, Rio Grande do Sul, Brazil.
AD  - Pharmacology Department, Instituto de Ciencias Basicas da Saude, Universidade 
      Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
FAU - Stefani, Luciana Cadore
AU  - Stefani LC
AD  - Department of Clinical Research Center, Laboratory of Pain & Neuromodulation, 
      Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, 
      Porto Alegre, Rio Grande do Sul, Brazil.
AD  - Surgery Department, Anesthesia and Perioperative Medicine, Hospital de Clinicas 
      de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio 
      Grande do Sul, Brazil.
FAU - Fregni, Felipe
AU  - Fregni F
AD  - Physical Medicine & Rehabilitation Department, Center of Neuromodulation & Center 
      for Clinical Research Learning, Spaulding Rehabilitation Hospital, Harvard 
      Medical School, Boston, Massachusetts, United States of America.
FAU - Caumo, Wolnei
AU  - Caumo W
AUID- ORCID: 0000-0002-5083-4658
AD  - Department of Clinical Research Center, Laboratory of Pain & Neuromodulation, 
      Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, 
      Porto Alegre, Rio Grande do Sul, Brazil.
AD  - Surgery Department, Anesthesia and Perioperative Medicine, Hospital de Clinicas 
      de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio 
      Grande do Sul, Brazil.
AD  - Pain and Palliative Care Service, Laboratory of Pain & Neuromodulation, Hospital 
      de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto 
      Alegre, Rio Grande do Sul, Brazil.
LA  - eng
SI  - ClinicalTrials.gov/NCT02360462
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20171130
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Brain-Derived Neurotrophic Factor)
SB  - IM
MH  - Adult
MH  - Brain-Derived Neurotrophic Factor/cerebrospinal fluid
MH  - Chronic Pain
MH  - Double-Blind Method
MH  - Female
MH  - Hallux Valgus/*surgery
MH  - Humans
MH  - Middle Aged
MH  - *Neuronal Plasticity
MH  - Pain, Postoperative/metabolism/*therapy
MH  - *Preoperative Care
MH  - Prospective Studies
MH  - *Transcranial Direct Current Stimulation
PMC - PMC5708693
COIS- Competing Interests: The authors have declared that no competing interests exist.
EDAT- 2017/12/01 06:00
MHDA- 2017/12/27 06:00
PMCR- 2017/11/30
CRDT- 2017/12/01 06:00
PHST- 2017/01/29 00:00 [received]
PHST- 2017/09/25 00:00 [accepted]
PHST- 2017/12/01 06:00 [entrez]
PHST- 2017/12/01 06:00 [pubmed]
PHST- 2017/12/27 06:00 [medline]
PHST- 2017/11/30 00:00 [pmc-release]
AID - PONE-D-17-01095 [pii]
AID - 10.1371/journal.pone.0187013 [doi]
PST - epublish
SO  - PLoS One. 2017 Nov 30;12(11):e0187013. doi: 10.1371/journal.pone.0187013. 
      eCollection 2017.