Pain, Postoperative
Conditions
Brief summary
The experience of pain derives from changes in brain excitability. Therefore, modulating the excitability of cortical areas involved in pain processing may become an attractive option in the context of multimodal analgesia during the postoperative period.
Detailed description
The combination of analgesic drugs acting on different mechanisms can potentiate the effects of analgesia. Moreover, the understanding of pain physiology at the molecular level supports the development of new specific drugs. Indeed, new neurophysiological models of pain processing by the brain are becoming exquisitely refined and are supported by electrophysiological and functional brain imaging studies. One of the interesting concepts that stemmed from these studies is the evidence that the experience of pain is reflected in the central nervous system by widespread activations and excitability changes within a network of interconnected cortical areas and subcortical structures. The network processing of noxious information and their limbic and emotional consequences has been termed the pain matrix. The continuous observation of the activity and excitability changes that parallel the pain experience led to the development of a new therapeutic approach: the use of central nervous system stimulation techniques.
Interventions
DEVICEtDCS sham motor cortex
the intervention 25 participants will be subjected to spine surgery then participants will be subjected to sham stimulation targeting left motor cortex area using the transcranial direct current stimulation device for 30 seconds then stop for 20 minutes.
DEVICEactive prefrontal cortex stimulation
the intervention 25 participants will be subjected to spine surgery then participants will be subjected to an active stimulation targeting left dorsolateral prefrontal cortex area using the transcranial direct current stimulation device with a current intensity of 2 mA for 20 min
DEVICEactive motor cortex stimulation
the intervention 25 participants will be subjected to spine surgery then participants will be subjected to an active stimulation targeting left motor cortex area using the transcranial direct current stimulation device with a current intensity of 2 mA for 20 min
Sponsors
Assiut University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* Able to give informed consent to participate in the study. * postoperative spine surgery patients(discectomy and/or laminectomy). * American society of anesthesiology scores I to II patients.
Exclusion criteria
the participant who has any history of: * an adverse reaction to brain stimulation. * a seizure * an unexplained loss of consciousness * a stroke * serious head injury * surgery to their head * any brain related, neurological illnesses * any illness that may have caused brain injury * frequent or severe headaches * metal in your head (outside the mouth) such as shrapnel, surgical clips, or fragments from welding * any implanted medical devices such as cardiac pacemaker's or medical pumps * taking any analgesic medications in the past 24 hours * pregnancy * anyone in your family has epilepsy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| the total consumption of morphine administered by patients during the first two days postoperative | 48 hours postoperative | the investigator will calculate the amount of morphine used during the first two days postoperative. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain severity assessment using visual analogue scale (VAS score from 0-10) | 30 minutes after every sessions and at the third day | the investigator will assess the pain at base line and at the end of sessions |
| HADS score | before surgery and at the third day | hospital anexiety and depression score |
Countries
Egypt, United Kingdom
Outcome results
None listed