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Feasibility of Non-invasive Brain Modulation for Management of Pain Related to Chemoradiotherapy in Patients with Advanced Head and Neck Cancer

View Article: PubMed Central - PubMed

ABSTRACT

Patients with head and neck cancer often experience a significant decrease in their quality of life during chemoradiotherapy (CRT) due to treatment-related pain, which is frequently classified as severe. Transcranial direct current stimulation (tDCS) is a method of non-invasive brain stimulation that has been frequently used in experimental and clinical pain studies. In this pilot study, we investigated the clinical impact and central mechanisms of twenty primary motor cortex (M1) stimulation sessions with tDCS during 7 weeks of CRT for head and neck cancer. From 48 patients screened, seven met the inclusion criteria and were enrolled. Electroencephalography (EEG) data were recorded before and after tDCS stimulation as well as across the trial to monitor short and long-term impact on brain function. The compliance rate during the long trial was extremely high (98.4%), and patients mostly reported mild side effects in line with the literature (e.g., tingling). Compared to a large standard of care study from our institution, our initial results indicate that M1-tDCS stimulation has a pain relief effect during the CRT that resulted in a significant attenuation of weight reduction and dysphagia normally observed in these patients. These results translated to our patient cohort not needing feeding tubes or IV fluids. Power spectra analysis of EEG data indicated significant changes in α, β, and γ bands immediately after tDCS stimulation and, in addition, α, δ, and θ bands over the long term in the seventh stimulation week (p < 0.05). The independent component EEG clustering analysis showed estimated functional brain regions including precuneus and superior frontal gyrus (SFG) in the seventh week of tDCS stimulation. These areas colocalize with our previous positron emission tomography (PET) study where there was activation in the endogenous μ-opioid system during M1-tDCS. This study provides preliminary evidence demonstrating the feasibility and safety of M1-tDCS as a potential adjuvant neuromechanism-driven analgesic therapy for head and neck cancer patients receiving CRT, inducing immediate and long-term changes in the cortical activity and clinical measures, with minimal side-effects.

No MeSH data available.


Study Protocol (* denotes simultaneous stimulation and EEG recording).
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Figure 1: Study Protocol (* denotes simultaneous stimulation and EEG recording).

Mentions: Once placed into their assigned study arms, patients presented 1 week prior to the start of CRT for the pre-study visit, consisting of a 20 min EEG recording, as well as questionnaires and data collection. During the first week of CRT, only questionnaires and data collection were completed. During weeks 2 and 3 of CRT, patients received daily tDCS stimulations (five per week), and completed weekly and daily questionnaires. During weeks 4 and 5 of CRT, patients received three tDCS stimulations per week; and During weeks 6 and 7, patients received two tDCS stimulations per week. In total, 20 tDCS sessions were applied across 6 weeks (5/5/3/3/2/2)(Figure 1). EEG was recorded for 10 min prior to, during, and for 10 min after tDCS stimulation at the first appointment of the second, third and seventh stimulation weeks. Additionally, EEG recordings were taken at the 1-week and 1-month follow-up appointments. If patients were unable to complete the stimulation or missed an appointment (due to weather, emergency, holiday, etc.), the stimulation appointment was rescheduled for the day before or the day after. If two stimulations were required on the same day to make up a missed appointment, one stimulation was performed in the morning and one in the afternoon, with a minimum of 3 h in between stimulation appointments.


Feasibility of Non-invasive Brain Modulation for Management of Pain Related to Chemoradiotherapy in Patients with Advanced Head and Neck Cancer
Study Protocol (* denotes simultaneous stimulation and EEG recording).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037215&req=5

Figure 1: Study Protocol (* denotes simultaneous stimulation and EEG recording).
Mentions: Once placed into their assigned study arms, patients presented 1 week prior to the start of CRT for the pre-study visit, consisting of a 20 min EEG recording, as well as questionnaires and data collection. During the first week of CRT, only questionnaires and data collection were completed. During weeks 2 and 3 of CRT, patients received daily tDCS stimulations (five per week), and completed weekly and daily questionnaires. During weeks 4 and 5 of CRT, patients received three tDCS stimulations per week; and During weeks 6 and 7, patients received two tDCS stimulations per week. In total, 20 tDCS sessions were applied across 6 weeks (5/5/3/3/2/2)(Figure 1). EEG was recorded for 10 min prior to, during, and for 10 min after tDCS stimulation at the first appointment of the second, third and seventh stimulation weeks. Additionally, EEG recordings were taken at the 1-week and 1-month follow-up appointments. If patients were unable to complete the stimulation or missed an appointment (due to weather, emergency, holiday, etc.), the stimulation appointment was rescheduled for the day before or the day after. If two stimulations were required on the same day to make up a missed appointment, one stimulation was performed in the morning and one in the afternoon, with a minimum of 3 h in between stimulation appointments.

View Article: PubMed Central - PubMed

ABSTRACT

Patients with head and neck cancer often experience a significant decrease in their quality of life during chemoradiotherapy (CRT) due to treatment-related pain, which is frequently classified as severe. Transcranial direct current stimulation (tDCS) is a method of non-invasive brain stimulation that has been frequently used in experimental and clinical pain studies. In this pilot study, we investigated the clinical impact and central mechanisms of twenty primary motor cortex (M1) stimulation sessions with tDCS during 7 weeks of CRT for head and neck cancer. From 48 patients screened, seven met the inclusion criteria and were enrolled. Electroencephalography (EEG) data were recorded before and after tDCS stimulation as well as across the trial to monitor short and long-term impact on brain function. The compliance rate during the long trial was extremely high (98.4%), and patients mostly reported mild side effects in line with the literature (e.g., tingling). Compared to a large standard of care study from our institution, our initial results indicate that M1-tDCS stimulation has a pain relief effect during the CRT that resulted in a significant attenuation of weight reduction and dysphagia normally observed in these patients. These results translated to our patient cohort not needing feeding tubes or IV fluids. Power spectra analysis of EEG data indicated significant changes in α, β, and γ bands immediately after tDCS stimulation and, in addition, α, δ, and θ bands over the long term in the seventh stimulation week (p < 0.05). The independent component EEG clustering analysis showed estimated functional brain regions including precuneus and superior frontal gyrus (SFG) in the seventh week of tDCS stimulation. These areas colocalize with our previous positron emission tomography (PET) study where there was activation in the endogenous μ-opioid system during M1-tDCS. This study provides preliminary evidence demonstrating the feasibility and safety of M1-tDCS as a potential adjuvant neuromechanism-driven analgesic therapy for head and neck cancer patients receiving CRT, inducing immediate and long-term changes in the cortical activity and clinical measures, with minimal side-effects.

No MeSH data available.