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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.


Related in: MedlinePlus

Intraoral Pain Area and Intensity During Chemoradiation/tDCS trial. All four patients reported only mild-to-moderate pain throughout their 7-week course of CRT. Using the GeoPain technology (MoxyTech LLC, MI), patients are able to quickly and efficiently illustrate their pain locations and pain intensity, allowing healthcare providers to both acknowledge current pain, as well as easily access and evaluate the patients pain history.
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Figure 6: Intraoral Pain Area and Intensity During Chemoradiation/tDCS trial. All four patients reported only mild-to-moderate pain throughout their 7-week course of CRT. Using the GeoPain technology (MoxyTech LLC, MI), patients are able to quickly and efficiently illustrate their pain locations and pain intensity, allowing healthcare providers to both acknowledge current pain, as well as easily access and evaluate the patients pain history.

Mentions: Four out of five stimulation patients reported scores of 0 at baseline, thus only control subjects with reported scores of 0 at baseline were used for optimal comparable analysis of the CTCAE grading system, and 64 of the control patients met these criteria. While none of the four stimulation patients had grade 3 dysphagia (0%), nine out of the 64 control patients that met the criteria reached grade 3 dysphagia (14.1%). Of those nine patients, some developed grade 3 dysphagia at week 2, while a majority developed grade 3 dysphagia between weeks 4 and 5, barely past their halfway mark of treatment. The difference between grade 2 (symptomatic eating/swallowing that alters eating habits) and grade 3 dysphagia (severely altered eating/swallowing habits), which lead to inadequate intake and possible indication for feeding tube placement, is clinically significant. Figure 6 shows intraoral pain area and intensity during chemoradiation/tDCS trial for all four patients receiving tDCS stimulation.


Feasibility of Non-invasive Brain Modulation for Management of Pain Related to Chemoradiotherapy in Patients with Advanced Head and Neck Cancer
Intraoral Pain Area and Intensity During Chemoradiation/tDCS trial. All four patients reported only mild-to-moderate pain throughout their 7-week course of CRT. Using the GeoPain technology (MoxyTech LLC, MI), patients are able to quickly and efficiently illustrate their pain locations and pain intensity, allowing healthcare providers to both acknowledge current pain, as well as easily access and evaluate the patients pain history.
© Copyright Policy
Related In: Results  -  Collection

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

Figure 6: Intraoral Pain Area and Intensity During Chemoradiation/tDCS trial. All four patients reported only mild-to-moderate pain throughout their 7-week course of CRT. Using the GeoPain technology (MoxyTech LLC, MI), patients are able to quickly and efficiently illustrate their pain locations and pain intensity, allowing healthcare providers to both acknowledge current pain, as well as easily access and evaluate the patients pain history.
Mentions: Four out of five stimulation patients reported scores of 0 at baseline, thus only control subjects with reported scores of 0 at baseline were used for optimal comparable analysis of the CTCAE grading system, and 64 of the control patients met these criteria. While none of the four stimulation patients had grade 3 dysphagia (0%), nine out of the 64 control patients that met the criteria reached grade 3 dysphagia (14.1%). Of those nine patients, some developed grade 3 dysphagia at week 2, while a majority developed grade 3 dysphagia between weeks 4 and 5, barely past their halfway mark of treatment. The difference between grade 2 (symptomatic eating/swallowing that alters eating habits) and grade 3 dysphagia (severely altered eating/swallowing habits), which lead to inadequate intake and possible indication for feeding tube placement, is clinically significant. Figure 6 shows intraoral pain area and intensity during chemoradiation/tDCS trial for all four patients receiving tDCS stimulation.

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.


Related in: MedlinePlus