Latin American and Caribbean consensus on noninvasive central nervous system neuromodulation for chronic pain management (LAC 2 -NIN-CP)

Baptista, Abrahão Fontes; Fernandes, Ana Mércia B.L.; Sa, Katia Nunes; Okano, Alexandre Hideki; Brunoni, André Russowsky; Lara-Solares, Argelia; Jreige Iskandar, Aziza; Guerrero, Carlos Arturo; Amescua-García, César; Kraychete, Durval Campos; Caparelli-Daquer, Egas Moniz; Atencio, Elías; Piedimonte, Fabián; Colimon, Frantz; Hazime, Fuad Ahmed; Garcia, João Batista S.; Hernández-Castro, John Jairo; Cantisani, José Alberto Flores; Karina do Monte-Silva, Kátia; Lemos Correia, Luís Cláudio; Gallegos, Manuel Sempértegui; Marcolin, Marco Antonio; Ricco, María Antonieta; Cook, María Berenguel; Bonilla, Patricia; Schestatsky, Pedro; Galhardoni, Ricardo; Silva, Valquiria M.; Delgado Barrera, William; Caumo, Wolnei; Bouhassira, Didier; Chipchase, Lucy S.; Lefaucheur, Jean-Pascal; Teixeira, Manoel Jacobsen; de Andrade, Daniel Ciampi

doi:10.1097/PR9.0000000000000692

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Latin American and Caribbean consensus on noninvasive central nervous system neuromodulation for chronic pain management (LAC ₂-NIN-CP)

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Author(s): Abrahão Fontes Baptista ^a ^, ^b ^, ^c ^, ^d ^, ^* , Ana Mércia B.L. Fernandes ^e , Katia Nunes Sá ^b , Alexandre Hideki Okano ^a , André Russowsky Brunoni ^f ^, ^g , Argelia Lara-Solares ^h , Aziza Jreige Iskandar ⁱ , Carlos Guerrero ^j , César Amescua-García ^k , Durval Campos Kraychete ^c , Egas Caparelli-Daquer ^l , Elias Atencio ^m , Fabián Piedimonte ⁿ , Frantz Colimon ^o , Fuad Ahmed Hazime ^p , João Batista S. Garcia ^q , John Jairo Hernández-Castro ^r , José Alberto Flores Cantisani ^s , Kátia Karina do Monte-Silva ^t , Luis Claudio Lemos Correia ^b ^, ^u , Manuel Sempértegui Gallegos ^v , Marco Antonio Marcolin ^e , María Antonieta Ricco ^w , María Berenguel Cook ^x , Patricia Bonilla ^y , Pedro Schestatsky ^z , Ricardo Galhardoni ^e ^, ^f ^, ^g ^, ^aa , Valquíria Silva ^e , William Delgado Barrera ^bb , Wolnei Caumo ^z , Didier Bouhassira ^cc , Lucy S. Chipchase ^dd , Jean-Pascal Lefaucheur ^ee , Manoel Jacobsen Teixeira ^e , Daniel Ciampi de Andrade ^e ^, ^f ^, ^g ^, ^ff ^, ^gg

Publication date (Electronic): 09 January 2019

Journal: Pain Reports

Publisher: Wolters Kluwer

Keywords: tDCS, rTMS, Neuropathic pain, Nociceptive pain, Mixed pain

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Abstract

Supplemental Digital Content is Available in the Text.

Abstract

Introduction:

Chronic pain (CP) is highly prevalent and generally undertreated health condition. Noninvasive brain stimulation may contribute to decrease pain intensity and influence other aspects related to CP.

Objective:

To provide consensus-based recommendations for the use of noninvasive brain stimulation in clinical practice.

Methods:

Systematic review of the literature searching for randomized clinical trials followed by consensus panel. Recommendations also involved a cost-estimation study.

Results:

The systematic review wielded 24 transcranial direct current stimulation (tDCS) and 22 repetitive transcranial magnetic stimulation (rTMS) studies. The following recommendations were provided: (1) Level A for anodal tDCS over the primary motor cortex (M1) in fibromyalgia, and level B for peripheral neuropathic pain, abdominal pain, and migraine; bifrontal (F3/F4) tDCS and M1 high-definition (HD)-tDCS for fibromyalgia; Oz/Cz tDCS for migraine and for secondary benefits such as improvement in quality of life, decrease in anxiety, and increase in pressure pain threshold; (2) level A recommendation for high-frequency (HF) rTMS over M1 for fibromyalgia and neuropathic pain, and level B for myofascial or musculoskeletal pain, complex regional pain syndrome, and migraine; (3) level A recommendation against the use of anodal M1 tDCS for low back pain; and (4) level B recommendation against the use of HF rTMS over the left dorsolateral prefrontal cortex in the control of pain.

Conclusion:

Transcranial DCS and rTMS are recommended techniques to be used in the control of CP conditions, with low to moderate analgesic effects, and no severe adverse events. These recommendations are based on a systematic review of the literature and a consensus made by experts in the field. Readers should use it as part of the resources available to decision-making.

Related collections

Most cited references 103

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Physiological basis of transcranial direct current stimulation.

Charlotte Stagg, Michael Nitsche (2011)

Since the rediscovery of transcranial direct current stimulation (tDCS) about 10 years ago, interest in tDCS has grown exponentially. A noninvasive stimulation technique that induces robust excitability changes within the stimulated cortex, tDCS is increasingly being used in proof-of-principle and stage IIa clinical trials in a wide range of neurological and psychiatric disorders. Alongside these clinical studies, detailed work has been performed to elucidate the mechanisms underlying the observed effects. In this review, the authors bring together the results from these pharmacological, neurophysiological, and imaging studies to describe their current knowledge of the physiological effects of tDCS. In addition, the theoretical framework for how tDCS affects motor learning is proposed.

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Neuropathic pain in the general population: a systematic review of epidemiological studies.

O van Hecke, Sophie K Austin, Rafi A Khan … (2014)

Most patients with neuropathic pain symptoms present and are managed in primary care, with only a minority being referred for specialist clinical assessment and diagnoses. Previous reviews have focused mainly on specific neuropathic pain conditions based in specialist settings. This is the first systematic review of epidemiological studies of neuropathic pain in the general population. Electronic databases were searched from January 1966 to December 2012, and studies were included where the main focus was on neuropathic pain prevalence and/or incidence, either as part of a specific neuropathic pain-related condition or as a global entity in the general population. We excluded studies in which data were extracted from pain or other specialist clinics or focusing on specific population subgroups. Twenty-one articles were identified and underwent quality assessment and data extraction. Included studies differed in 3 main ways: method of data retrieval, case ascertainment tool used, and presentation of prevalence/incidence rates. This heterogeneity precluded any meta-analysis. We categorised comparable incidence and prevalence rates into 2 main subgroups: (1) chronic pain with neuropathic characteristics (range 3-17%), and (2) neuropathic pain associated with a specific condition, including postherpetic neuralgia (3.9-42.0/100,000 person-years [PY]), trigeminal neuralgia (12.6-28.9/100,000 PY), painful diabetic peripheral neuropathy (15.3-72.3/100,000 PY), glossopharyngeal neuralgia (0.2-0.4/100,000 PY). These differences highlight the importance of a standardised approach for identifying neuropathic pain in future epidemiological studies. A best estimate of population prevalence of pain with neuropathic characteristics is likely to lie between 6.9% and 10%. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

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Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment.

Ralf Baron, Andreas Binder, Gunnar Wasner (2010)

Neuropathic pain develops as a result of lesions or disease affecting the somatosensory nervous system either in the periphery or centrally. Examples of neuropathic pain include painful polyneuropathy, postherpetic neuralgia, trigeminal neuralgia, and post-stroke pain. Clinically, neuropathic pain is characterised by spontaneous ongoing or shooting pain and evoked amplified pain responses after noxious or non-noxious stimuli. Methods such as questionnaires for screening and assessment focus on the presence and quality of neuropathic pain. Basic research is enabling the identification of different pathophysiological mechanisms, and clinical assessment of symptoms and signs can help to determine which mechanisms are involved in specific neuropathic pain disorders. Management of neuropathic pain requires an interdisciplinary approach, centred around pharmacological treatment. A better understanding of neuropathic pain and, in particular, of the translation of pathophysiological mechanisms into sensory signs will lead to a more effective and specific mechanism-based treatment approach. Copyright 2010 Elsevier Ltd. All rights reserved.

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Author and article information

Journal

Journal ID (nlm-ta): Pain Rep

Journal ID (iso-abbrev): Pain Rep

Journal ID (coden): PAIREP

Journal ID (publisher-id): Painreports

Title: Pain Reports

Publisher: Wolters Kluwer (Philadelphia, PA )

ISSN (Electronic): 2471-2531

Publication date Collection: Jan-Feb 2019

Publication date (Electronic): 09 January 2019

Volume: 4

Issue: 1

Electronic Location Identifier: e692

Affiliations

[a ]Universidade Federal do ABC, Centro de Matemática, Computação e Cognição, São Bernardo do Campo, São Paulo, Brazil

[b ]Departamento de Pós-graduação, Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil

[c ]Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Bahia, Brazil

[d ]Universidade de São Paulo, LIM-54, São Paulo, Brazil

[e ]Department of Neurology, Pain Center, Universidade de São Paulo, São Paulo, Brazil

[f ]Interdisciplinary Center for Applied Neuromodulation, University Hospital, University of São Paulo, São Paulo, Brazil

[g ]Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of Sao Paulo, São Paulo, Brazil

[h ]Department of Pain Medicine and Palliative Care, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City, Mexico

[i ]Rehabilitation Residency Program, Universidad Central de Venezuela, Unidad de Rehabilitación DM, Maracay, Venezuela

[j ]Hospital Universitario Fundación Santa Fe, Bogotá, Clinica de Dolor e Departamento de Anestesia, Universidad de los Andes, Bogotá, Colombia

[k ]Hospital Angeles, Unidad de Dolor de Tijuana, Tijuana, Mexico

[l ]Universidade do Estado do Rio de Janeiro, Centro Biomédico, Instituto de Biologia Roberto Alcantara Gomes, Rio de Janeiro, Brazil

[m ]Complejo Hospitalario Metropolitano, Caja de Seguro Social, Pain Clinic, Panama City, Panama

[n ]Departamento de Neurocirurgía, Faculdade de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina

[o ]Centro Oncológico de Antioquia, Interventional Pain Management and Palliative Care Unit, Centro Oncológico de Antioquia, Colombia

[p ]Departamento de Fisioterapia, Universidade Federal do Piauí, Parnaíba, Parnaíba, Brazil

[q ]Departamento de Medicina, Centro de Ciências Biológicas e da Saúde, Universidade Federal do Maranhão, São Luís, Maranhão, Brazil

[r ]Escuela de Medicina y Ciencias de La Salud, Universidad de Rosario, Bogotá, Colombia

[s ]Programa Regional de Cuidados Paliativos, Unidad Médica de Alta Especialidad No. 25, IMSS, Monterrey, Nuevo León, México

[t ]Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil

[u ]Hospital São Rafael, Departamento de Cardiologia, Salvador, Brazil

[v ]Clinica de Dolor, Hospital Metropolitano, Quito, Ecuador

[w ]Clinica Alemana de Santiago, Santiago, Chile

[x ]Departamento de Medicina Paliativa y Tratamiento del Dolor, Totalcare-Oncosalud-Auna, Lima, Peru

[y ]Universidad Tecnica Particular de Loja, Titulación de Medicina, Loja, Ecuador

[z ]Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil

[aa ]Escola de Medicina, Universidade Cidade de São Paulo, São Paulo, Brazil

[bb ]Hospital Clínica Bíblica, Clinica de Dolor, San José, Costa Rica

[cc ]INSERM U-987, Pathophysiology and Clinical Pharmacology of Pain, Centre d'Evaluation et de Traitement de la Douleur Hôpital Ambroise Paré, France

[dd ]Dean's Unit, School of Science and Health, Western Sydney University, Campbelltown, Australia

[ee ]EA 4391, Service de Physiologie, Hôpital Henri Mondor, AP-HP, Faculté de Médecine, Université Paris-Est Créteil, Créteil, France

[ff ]Instituto do Câncer, Centro de Dor, Universidade de São Paulo, São Paulo, Brazil

[gg ]LIM-62, Neurosurgery—Interventional Neurosurgery HC-FMUSP

Author notes

[* ]Correspondence author. Address: Center for Mathematics, Computation and Cognition, UFABC, Alameda da Universidade, s/n, Room 244-Delta, Anchieta, São Bernardo do Campo, São Paulo 09606-045, Brazil. Tel.: +55 11 2320-6270. E-mail address: a.baptista@ 123456ufabc.edu.br (A.F. Baptista).

Article

Publisher ID: PAINREPORTS-D-18-0073 Accession ID: 00001

DOI: 10.1097/PR9.0000000000000692

PMC ID: 6370142

PubMed ID: 30801041

SO-VID: 3f6109be-4a3a-495c-959a-aeb074f8a861

License:

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike License 4.0 (CCBY-NC-SA) which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

History

Date received : 26 August 2018

Date accepted : 5 September 2018

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Keywords: tdcs,rtms,neuropathic pain,nociceptive pain,mixed pain

Data availability:

Keywords: tdcs, rtms, neuropathic pain, nociceptive pain, mixed pain