NEUROMODULAÇÃO PERIFÉRICA POR MEIO DE AGULHAS E ESTIMULAÇÃO ELÉTRICA

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sináptico e up-regulation do tônus sináptico mediado pelo receptor NMDA e dependente da síntese de proteína, modificações na concentração de adenosina monofosfato (AMP) cíclico intracelular e do influxo da corrente de cálcio intracelular. Esses processos fazem parte dos fenômenos longterm potention (LTP- Potenciação de longa duração) e long-term depression (LTD – depressão de longa duração). LTP corresponde a um processo de facilitação do sistema nervoso, enquanto LTD – enfraquece a transmissão sináptica..

Clin J Pain.2014 Mar;30(3):214-23. doi: 10.1097/AJP.0b013e3182934b8d. Paraspinal stimulation combined with trigger point needling and needle rotation for the treatment of myofascial pain: a randomized sham-controlled clinical trial.

Couto C1,de Souza IC,Torres IL,Fregni F,Caumo W.

BACKGROUND: There are different types and parameters of dryneedling(DN) that can affect its efficacy in the treatment of pain that have not been assessed properly. OBJECTIVE: To test the hypothesis that either multiple deep intramuscularstimulationtherapy multiple deep intramuscularstimulation therapy (MDIMST) or TrP lidocaine injection (LTrP-I) is more effective than a placebo-sham for the treatment of myofascial pain syndrome (MPS) and that MDIMST is more effective than LTrP-I for improving pain relief, sleep quality, and the physical and mental state of the patient. METHODS: Seventy-eight females aged 20 to 40 who were limited in their ability to perform active and routine activities due to MPS in the previous 3 months were recruited. The participants were randomized into 1 of the 3 groups as follows: placebo-sham, LTrP-I, or MDIMST. The treatments were provided twice weekly over 4 weeks using standardized MDIMST and LTrP-I protocols. RESULTS: There was a significant interaction (time vs. group) for the main outcomes. Compared with the sham-treated group, MDIMST and LTrP-I administration improved pain scores based on a visual analog scale, the pain pressure threshold (P<0.001 for all analyses), and analgesic use (P<0.01 for all analyses). In addition, when comparing the active groups for these outcomes, MDIMST resulted in better improvement than LTrP-I (P<0.01 for all analyses). In addition, both active treatments had a clinical effect, as assessed by a sleep diary and by the SF-12 physical and mental health scores. CONCLUSIONS: This study highlighted the greater efficacy of MDIMST over the placebo-sham and LTrP-I and indicated that both active treatments are more effective than placebo-sham for MPS associated with limitations in active and routine activities. No: 43 FI: 2.89 Citações: 41

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Pain Med.2016 Jan;17(1):122-35.

Effect of Deep Intramuscular Stimulation and Transcranial Magnetic Stimulation on Neurophysiological Biomarkers in Chronic Myofascial Pain Syndrome.

Medeiros LF,Caumo W,Dussán-Sarria J,Deitos A,Brietzke A,Laste G,Campos-Carraro C,de Souza A,Scarabelot VL,Cioato SG,Vercelino R,de Castro AL,Araújo AS,Belló-Klein A,Fregni F,Torres IL.

The aim was to assess the neuromodulation techniques effects (repetitive transcranial magnetic stimulation [rTMS] and deep intramuscular stimulation therapy [DIMST]) on pain intensity, peripheral, and neurophysiological biomarkers chronic myofascial pain syndrome (MPS) patients. Randomized, double blind, factorial design, and controlled placebo-sham clinical trial. Clinical trial in the Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (NCT02381171). We recruited women aged between 19- and 75-year old, with MPS diagnosis. Patients were randomized into four groups: rTMS + DIMST, rTMS + sham-DIMST, sham-rTMS + DIMST, sham-rTMS + sham-DIMST; and received 10 sessions for 20 minutes each one (rTMS and DIMST). Pain was assessed by visual analogue scale (VAS); neurophysiological parameters were assessed by transcranial magnetic stimulation; biochemical parameters were: BDNF, S100β, lactate dehydrogenase, inflammatory (TNF-α, IL6, and IL10), and oxidative stress parameters. We observed the pain relief assessed by VAS immediately assessed before and after the intervention (P < 0.05, F(1,3)= 3.494 and F(1,3)= 4.656, respectively); in the sham-rTMS + DIMST group and both three active groups in relation to sham-rTMS + sham-DIMST group, respectively. There was an increase in the MEP after rTMS + sham-DIMST (P < 0.05). However, there was no change in all-peripheral parameters analyzed across the treatment (P > 0.05). Our findings add additional evidence about rTMS and DIMST in relieving pain in MPS patients without synergistic effect. No peripheral biomarkers reflected the analgesic effect of both techniques; including those related to cellular damage. Additionally, one neurophysiological parameter (increased MEP amplitude) needs to be investigated. No: 44 FI: 2.78 Citações: 10

BMC Complement Altern Med.2015 May 7;15:144. doi: 10.1186/s12906-015-0664-x. Electroacupuncture analgesia is associated with increased serum brain-derived neurotrophic factor in chronic tension-type headache: a randomized, sham controlled, crossover trial.

Chassot M1,2,Dussan-Sarria JA3,4,5,Sehn FC6,7,Deitos A8,9,de Souza A10,11,Vercelino R12,13,Torres IL14,15,Fregni F16,Caumo W17,18,19,20.

BACKGROUND: Chronictension-typeheadache(CTTH) ischaracterizedby almostdailyheadachesandcentral sensitization, for whichelectroacupuncture (EA) might be effective. Thecentralnervous system(CNS) plasticity can be tracked in serum using the brain-derived neurotrophic factor (BDNF), a neuroplasticity mediator. Thus, we tested the hypothesis thatEAanalgesia inCTTHis related to neuroplasticity indexed by serum BDNF. METHODS: We enrolled females aged 18-60 years withCTTHin a randomized, blinded, placebo-controlled crossover trial, comparing tenEA sessions applied for 30 minutes (2-10 Hz, intensity by tolerance) in cervical areas twice per week vs. a sham intervention. Treatment periods were separated by two washout weeks. Pain on the 10-cm visual analog scale (VAS) and serum BDNF were assessed as

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primary outcomes. RESULTS: Thirty-four subjects underwent randomization, and twenty-nine completed the protocol.EAwas superior to sham to alleviate pain (VAS scores 2.38 ± 1.77 and 3.02 ± 2.49, respectively, P = 0.005). The VAS scores differed according to the intervention sequence, demonstrating a carryover effect (P < 0.05). Using multiple regression, serum BDNF was adjusted for the Hamilton depression rating scale (HDRS) and the VAS scores (r-squared = 0.07, standard β coefficients = -0.2 and -0.14, respectively, P < 0.001). At the end of the first intervention period, the adjusted BDNF was higher in theEAphase (29.31 ± 3.24, 27.53 ± 2.94 ng/mL, Cohen’s d = 0.55). CONCLUSION: EAanalgesia is related to neuroplasticity indexed by the adjusted BDNF.EAmodulation of pain and BDNF occurs according to the CNS situation at the moment of its administration, as it was related to depression and the timing of its administration. No: 45 FI: 2.82 Citações: 26

JPain.2014 Aug;15(8):845-55. doi: 10.1016/j.jpain.2014.05.001. Epub 2014 May 24. Repetitive transcranial magnetic stimulation increases the corticospinal inhibition and the brain-derived neurotrophic factor in chronic myofascial pain syndrome: an explanatory double-blinded, randomized, sham-controlled trial.

Dall’Agnol L1,Medeiros LF2,Torres IL3,Deitos A1,Brietzke A1,Laste G4,de Souza A5,Vieira JL6,Fregni F7,Caumo W8.

Chronicmyofascial pain syndromehas been related to defective descending inhibitory systems. Twenty-four females aged 19 to 65 years withchronicmyofascial pain syndromewere randomized to receive 10 sessions of repetitive transcranial magnetic stimulation (rTMS) (n = 12) at 10 Hz or a sham intervention (n = 12). We tested ifpain(quantitative sensory testing), descending inhibitory systems (conditionedpain modulation [quantitative sensory testing + conditionedpainmodulation]), cortical excitability (TMS parameters), and the brain-derived neurotrophic factor (BDNF) would be modified. There was a significant interaction (time vs group) regarding the main outcomes of thepain scores as indexed by the visual analog scale onpain(analysis of variance, P < .01). Post hoc analysis showed that compared with placebo-sham, the treatment reduced dailypainscores by -30.21% (95% confidence interval = -39.23 to -21.20) and analgesic use by -44.56 (-57.46 to -31.67). Compared to sham, rTMS enhanced the corticospinal inhibitory system (41.74% reduction in quantitative sensory testing + conditionedpainmodulation, P < .05), reduced the intracortical facilitation in 23.94% (P = .03), increased the motor evoked potential in 52.02% (P = .02), and presented 12.38 ng/ mL higher serum BDNF (95% confidence interval = 2.32-22.38). No adverse events were observed. rTMS analgesic effects inchronicmyofascial pain syndromewere mediated by top-down regulation mechanisms, enhancing the corticospinal inhibitory system possibly via BDNF secretion modulation. PERSPECTIVE: High-frequency rTMS analgesic effects were mediated by top-down regulation mechanisms enhancing the corticospinal inhibitory, and this effect involved an increase in BDNF secretion. No: 46 FI: 5.2 Citações: 50

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Front Hum Neurosci.2018 Oct 16;12:388. doi: 10.3389/fnhum.2018.00388. eCollection 2018.InsightsAbout theNeuroplasticityStateon

Insights About the Neuroplasticity State on the Effect of Intramuscular Electrical Stimulation in Pain and Disability Associated With Chronic Myofascial Pain Syndrome (MPS): A Double-Blind, Randomized, Sham-Controlled Trial.

Botelho L1,2,3,4,Angoleri L2,3,Zortea M1,2,3,Deitos A1,Brietzke A1,Torres ILS1,5,Fregni F6,Caumo W

Background:There is limited evidence concerning the effect of intramuscular electrical stimulation(EIMS) on the neural mechanisms of painand disability associated with chronic Myofascial Pain Syndrome (MPS). Objectives:To provide newinsightsinto the EIMS long-termeffect on pain and disability related tochronicMPS(primary outcomes). To assess if theneuroplasticitystateat baseline could predict the long-term impact of EIMS ondisabilitydue toMPSwe examined the relationship between the serum brainderived-neurotrophic-factor (BDNF) and by motor evoked potential (MEP). Also, we evaluated if the EIMS could improve the descendingpain modulatory system (DPMS) and the cortical excitability measured by transcranial magneticstimulation(TMS) parameters.Methods: We included 24 right-handed female withchronicMPS, 19-65 years old. They were randomically allocated to receive ten sessions of EIMS, 2 Hz at the cervical paraspinal region or a sham intervention (n= 12).Results:A mixed model analysis of variance revealed that EIMS decreased dailypain scores by -73.02% [95% confidence interval (CI) = -95.28 to -52.30] anddisabilitydue topain-43.19 (95%CI, -57.23 to -29.39) at 3 months of follow up. The relative risk for using analgesics was 2.95 (95% CI, 1.36 to 6.30) in the sham group. In the EIMS and sham, the change on the NumericalPainScale (NPS0-10) throughout CPM-task was -2.04 (0.79) vs. -0.94 (1.18), respectively, (P= 0.01). EIMS reduced the MEP -28.79 (-53.44 to -4.15), while improved DPMS and intracortical inhibition. The MEP amplitude before treatment [(Beta = -0.61, (-0.58 to -0.26)] and a more significant change from pre- to post-treatment on serum BDNF) (Beta = 0.67; CI95% = 0.07 to 1.26) were predictors to EIMSeffectonpainanddisabilitydue topain.Conclusion:These findings suggest that a bottomupeffectinduced by the EIMS reduced the analgesic use, improvedpain, anddisabilitydue tochronicMPS. Thiseffectmight be mediated by an enhancing of corticospinal inhibition as seen by an increase in IC and a decrease in MEP amplitude. Likewise, the MEP amplitude before treatment and the changes induced by the EIMS in the serum BDNF predicted it’s long-term clinical impact onpainanddisabilitydueMPS.Thetrialis recorded in ClinicalTrials.gov:NCT02381171. No: 47 FI: 2.87 Citações: 1