Cláudio Fernandes Correa

Transcranial DC stimulation coupled with TENS for the treatment of chronic pain : a preliminary study

ObjectiveBased on evidence showing that electrical stimulation of the nervous system is an effective method to decrease chronic neurogenic pain, we aimed to investigate whether the combination of 2 methods of electrical stimulation—a method of peripheral stimulation [transcutaneous electrical nerve stimulation (TENS)] and a method of noninvasive brain stimulation [transcranial direct current stimulation (tDCS)]—induces greater pain reduction as compared with tDCS alone and sham stimulation. MethodsWe performed a preliminary, randomized, sham-controlled, crossover, clinical study in which 8 patients were randomized to receive active tDCS/active TENS (“tDCS/TENS” group), active tDCS/sham TENS (“tDCS” group), and sham tDCS/sham TENS (“sham” group) stimulation. Assessments were performed immediately before and after each condition by a blinded rater. ResultsThe results showed that there was a significant difference in pain reduction across the conditions of stimulation (P=0.006). Post hoc tests showed significant pain reduction as compared with baseline after the tDCS/TENS condition [reduction by 36.5% (±10.7), P=0.004] and the tDCS condition [reduction by 15.5% (±4.9), P=0.014], but not after sham stimulation (P=0.35). In addition, tDCS/TENS induced greater pain reduction than tDCS (P=0.02). ConclusionsThe results of this pilot study suggest that the combination of TENS with tDCS has a superior effect compared with tDCS alone.

Neuromodulation approaches for the treatment of major depression: challenges and recommendations from a working group meeting

UNLABELLED The use of neuromodulation as a treatment for major depressive disorder (MDD) has recently attracted renewed interest due to development of other non-pharmacological therapies besides electroconvulsive therapy (ECT) such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), deep brain stimulation (DBS), and vagus nerve stimulation (VNS). METHOD We convened a working group of researchers to discuss the updates and key challenges of neuromodulation use for the treatment of MDD. RESULTS The state-of-art of neuromodulation techniques was reviewed and discussed in four sections: [1] epidemiology and pathophysiology of MDD; [2] a comprehensive overview of the neuromodulation techniques; [3] using neuromodulation techniques in MDD associated with non-psychiatric conditions; [4] the main challenges of neuromodulation research and alternatives to overcome them. DISCUSSION ECT is the first-line treatment for severe depression. TMS and tDCS are strategies with a relative benign profile of side effects; however, while TMS effects are comparable to antidepressant drugs for treating MDD; further research is needed to establish the role of tDCS. DBS and VNS are invasive strategies with a possible role in treatment-resistant depression. In summary, MDD is a chronic and incapacitating condition with a high prevalence; therefore clinicians should consider all the treatment options including invasive and non-invasive neuromodulation approaches.

Incapacidade relacionada à dor lombar crônica: prevalência e fatores associados

Disability related to chronic low back pain (CLBP) is a complex and multidimensional phenomenon. The aim of the study was to identify the prevalence of disability and factors associated with disability outcome in 177 CLBP adults. Respondents were recruited from three health care service centers and answered questions from: Demographic Identification Form, Oswestry Disability Index, Chronic Pain Self-efficacy Scale, Tampa Scale Kinesiophobia, Beck Depression Inventory, and the Revised Piper Fatigue Scale. The prevalence of disability among the respondents was 65% (95% CI: 57.5 - 72.0), and disability was moderate to severe in 80.7% of them. The multiple regression model identified three factors as independently associated with disability: work situation, low self-efficacy and depression. The factors identified to be associated with disability are modifiable. Interventions such as work relocation, depression treatment and re-conceptualization of self-efficacy may have an important impact in preventing and reducing disability in chronic low back pain patients.A incapacidade relacionada a dor lombar cronica (DLC) e um fenomeno complexo e multifatorial. O objetivo desse estudo foi identificar a prevalencia e os fatores associados a incapacidade em pacientes com dor lombar cronica. Estudo transversal com amostra composta por 177 pacientes com DLC, de tres servicos de saude; que responderam ao formulario com dados demograficos, ao Inventario de Depressao de Beck, as Escalas Oswestry Disability Index, de autoeficacia para dor cronica, Tampa de Cinesiofobia e de Fadiga de Piper. A prevalencia de incapacidade foi de 65% (IC95%: 57,5 - 72,0) e era de moderada a grave em 80,7% dos pacientes. O modelo de regressao multipla identificou tres fatores independentemente associados a incapacidade: ausencia de trabalho remunerado, autoeficacia baixa e depressao. Os fatores associados a incapacidade identificados sao modificaveis. Intervencoes como recolocacao no trabalho, tratamento para a depressao e reconceitualizacao da crenca de autoeficacia podem ter um impacto importante na prevencao e reducao de incapacidade.

[Disability related to chronic low back pain: prevalence and associated factors].

Disability related to chronic low back pain (CLBP) is a complex and multidimensional phenomenon. The aim of the study was to identify the prevalence of disability and factors associated with disability outcome in 177 CLBP adults. Respondents were recruited from three health care service centers and answered questions from: Demographic Identification Form, Oswestry Disability Index, Chronic Pain Self-efficacy Scale, Tampa Scale Kinesiophobia, Beck Depression Inventory, and the Revised Piper Fatigue Scale. The prevalence of disability among the respondents was 65% (95% CI: 57.5 - 72.0), and disability was moderate to severe in 80.7% of them. The multiple regression model identified three factors as independently associated with disability: work situation, low self-efficacy and depression. The factors identified to be associated with disability are modifiable. Interventions such as work relocation, depression treatment and re-conceptualization of self-efficacy may have an important impact in preventing and reducing disability in chronic low back pain patients.A incapacidade relacionada a dor lombar cronica (DLC) e um fenomeno complexo e multifatorial. O objetivo desse estudo foi identificar a prevalencia e os fatores associados a incapacidade em pacientes com dor lombar cronica. Estudo transversal com amostra composta por 177 pacientes com DLC, de tres servicos de saude; que responderam ao formulario com dados demograficos, ao Inventario de Depressao de Beck, as Escalas Oswestry Disability Index, de autoeficacia para dor cronica, Tampa de Cinesiofobia e de Fadiga de Piper. A prevalencia de incapacidade foi de 65% (IC95%: 57,5 - 72,0) e era de moderada a grave em 80,7% dos pacientes. O modelo de regressao multipla identificou tres fatores independentemente associados a incapacidade: ausencia de trabalho remunerado, autoeficacia baixa e depressao. Os fatores associados a incapacidade identificados sao modificaveis. Intervencoes como recolocacao no trabalho, tratamento para a depressao e reconceitualizacao da crenca de autoeficacia podem ter um impacto importante na prevencao e reducao de incapacidade.

Exploring a novel therapeutic approach with noninvasive cortical stimulation for vulvodynia

Existing therapies for vulvodynia are inadequate. Because vulvodynia has a pathophysiology similar to chronic pain, central nervous system dysfunction may underlie this painful disorder, and noninvasive methods of neuromodulation may prove highly effective. We report a case of severe, medically refractory vulvodynia that responded remarkably to treatment with transcranial direct current stimulation.

VANets: An Exploratory Evaluation in Vehicular Ad Hoc Network for Urban Environment

Vehicular Ad hoc Network (VANET) is a promising communication technology suitable for vehicular mobile networks. Represent networks of singular features, wherein the data dissemination is fundamental. The literature is plentiful in protocols, usually specific to address individual issues in well-defined scenarios. This work efforts are concentrated, mainly, to examine operating settings in protocols like AID, DBRS, and ADDHV for disseminating messages. A benchmarking explores strategies that address challenges such as network partitioning and the broadcast storm problem, which undertake the dissemination. The results of a set of metrics obtained in different vehicular traffic schemes complete the discussion held. Considerations for answers in coverage, delay, rate of delivery, broadcast, and packet loss support this initiative and motivate the development of an adaptive solution to fluctuations in carrier density.

Opiáceo intratecal na dor crônica não neoplásica: alívio e qualidade de vida

O uso de agentes morfinicos para o controle da dor cronica nao relacionada a câncer e controverso. Este estudo aferiu o alivio da dor e as mudancas nas atividades de 11 doentes com dor cronica nao associada ao câncer, tratados pela infusao intratecal de farmacos morfinicos atraves de bombas implantaveis. A dor era neuropatica em 5 doentes e miofascial em 6. A duracao media da queixa algica foi 5,3 anos. A media da intensidade da dor antes da infusao foi 8,6. Sete doentes apresentavam dor durante 6 ou mais horas por dia. Apos o tratamento, a media de intensidade da dor reduziu-se para 3,9. Somente 1 doente manteve dor com duracao superior a 6 horas. O tratamento melhorou o desempenho de 36,36% dos aspectos funcionais avaliados. O tempo medio de tratamento foi 19,6 meses. A infusao cronica de agentes morfinicos por via intratecal proporcionou alivio da dor, mas nao melhorou a funcionalidade com a mesma magnitude.The use of opioids for treatment of non-malignant pain is controversial. The evaluation of pain relief and of the quality of life of 11 severely incapacitated chronic non-cancer pain patients treated with long term intrathecal infusion of opioids trought implantable pumps was performed. The mean duration of pain complaints was 5.3 years. The mean pain intensity was 8.6. In 7 patients, pain episodes lasted at least 6 hours daily. The mean duration of the therapy was 19.6 months. After the treatment the mean pain score became 3.9. In only 1 patient, the duration of pain episodes was still longer than 6 hours. Quality of life improved in 36.36% of the cases. The long term spinal opioids through implantable pumps for non-malignant pains results in pain relief but not necessarily improves the quality of life.The use of opioids for treatment of non-malignant pain is controversial. The evaluation of pain relief and of the quality of life of 11 severely incapacitated chronic non-cancer pain patients treated with long term intrathecal infusion of opioids trought implantable pumps was performed. The mean duration of pain complaints was 5.3 years. The mean pain intensity was 8.6. In 7 patients, pain episodes lasted at least 6 hours daily. The mean duration of the therapy was 19.6 months. After the treatment the mean pain score became 3.9. In only 1 patient, the duration of pain episodes was still longer than 6 hours. Quality of life improved in 36.36% of the cases. The long term spinal opioids through implantable pumps for non-malignant pains results in pain relief but not necessarily improves the quality of life.

Alívio da dor crônica não neoplásica com opiáceos

O uso de opiaceos para o controle da dor cronica nao relacionada ao câncer e controverso. Avaliar o alivio da dor e as mudancas nas atividades de vida diaria advindas da infusao intratecal de opiaceos em 11 doentes, com dor cronica nao neoplasica, foram os objetivos deste estudo. Todos os doentes haviam previamente sido submetidos a diversas modalidades terapeuticas sem alivio significativo. Os doentes foram solicitados a avaliar as caracteristicas da dor e as atividades de vida diaria comparando-as antes e apos o tratamento com opiaceo intratecal por meio de sistemas implantados. Observou-se alivio da dor. No entanto, melhora da funcionalidade nao foi observada com a mesma magnitude.Opioids for non cancer pain control are controversial. The evaluation of the pain relief, changes in quality of life and complications due to long term infusion of opioids in the lumbar subarachnoid space in 11 patients with non cancer pain were the goals of this study. Patients were previously treated with drugs and surgical procedures, without significant pain relief. Patients were asked to compare pain characteristics and daily life activities before and after this treatment. The long term spinal opioids through implantable pumps for non-oncologic pain produced pain relief but did not improve the quality of life in the majority of the cases.

Ad hoc vehicular: Exploratory evaluation of a vehicular ad hoc network in Urban and highway settings

A Vehicular Ad hoc network (VANET) represents a unique subset among mobile ad hoc networks (MANET), in which the nodes are vehicles provided with their own communications technology. In this paper, there is a convergence of approaches to meet expectations with regard to examining performance in the operational settings in protocols like AID, DBRS, SRD, and the ADDHV, which are designed to disseminate messages. A comparative evaluation makes it possible to explore the strategies employed by these protocols when faced with challenges such as network partition and the problem of broadcast storm, which can damage the dissemination process. The results shown as a set of metrics obtained in different vehicular traffic schemes complete the investigation.

Incapacidad relacionada con el dolor lumbar crónico: prevalencia y factores asociados

Disability related to chronic low back pain (CLBP) is a complex and multidimensional phenomenon. The aim of the study was to identify the prevalence of disability and factors associated with disability outcome in 177 CLBP adults. Respondents were recruited from three health care service centers and answered questions from: Demographic Identification Form, Oswestry Disability Index, Chronic Pain Self-efficacy Scale, Tampa Scale Kinesiophobia, Beck Depression Inventory, and the Revised Piper Fatigue Scale. The prevalence of disability among the respondents was 65% (95% CI: 57.5 - 72.0), and disability was moderate to severe in 80.7% of them. The multiple regression model identified three factors as independently associated with disability: work situation, low self-efficacy and depression. The factors identified to be associated with disability are modifiable. Interventions such as work relocation, depression treatment and re-conceptualization of self-efficacy may have an important impact in preventing and reducing disability in chronic low back pain patients.A incapacidade relacionada a dor lombar cronica (DLC) e um fenomeno complexo e multifatorial. O objetivo desse estudo foi identificar a prevalencia e os fatores associados a incapacidade em pacientes com dor lombar cronica. Estudo transversal com amostra composta por 177 pacientes com DLC, de tres servicos de saude; que responderam ao formulario com dados demograficos, ao Inventario de Depressao de Beck, as Escalas Oswestry Disability Index, de autoeficacia para dor cronica, Tampa de Cinesiofobia e de Fadiga de Piper. A prevalencia de incapacidade foi de 65% (IC95%: 57,5 - 72,0) e era de moderada a grave em 80,7% dos pacientes. O modelo de regressao multipla identificou tres fatores independentemente associados a incapacidade: ausencia de trabalho remunerado, autoeficacia baixa e depressao. Os fatores associados a incapacidade identificados sao modificaveis. Intervencoes como recolocacao no trabalho, tratamento para a depressao e reconceitualizacao da crenca de autoeficacia podem ter um impacto importante na prevencao e reducao de incapacidade.