Neuromodulation treats Chikungunya arthralgia: a randomized controlled trial

Abstract

The Chikungunya (CHIK) virus is epidemic in Brazil, with 170,000 cases in the first half of 2016. More than 60% of patients present relapsing and remitting chronic arthralgia with debilitating pain lasting years. There are no specific therapeutic agents to treat and rehabilitee infected persons with CHIK. Persistent pain can lead to incapacitation, requiring long-term pharmacological treatment. Advances in non-pharmacological treatments are necessary to promote pain relief without side effects and to restore functionality. Clinical trials indicate transcranial direct current stimulation (tDCS) can treat a broad range of chronic pain disorders, including diffuse neuromuscular pain and arthralgia. Here, we demonstrate that the tDCS across the primary motor cortex significantly reduces pain in the chronic phase of CHIK. High-resolution computational model was created to analyze the cortical electric field generated during tDCS and a diffuse and clustered brain current flow including M1 ipsilateral and contralateral, left DLPFC, nucleus accumbens, and cingulate was found. Our findings suggest tDCS could be an effective, inexpensive and deployable therapy to areas lacking resources with a significant number of patients with chronic CHIK persistent pain.

Analysis of Different Device Interactions in a Virtual Reality Task in Individuals With Duchenne Muscular Dystrophy—A Randomized Controlled Trial

“…Post-hoc comparisons were carried out using Tukey-LSD (Least Significance Difference). Partial eta-squared (η p 2 ) was reported to measure effect size and was interpreted as small (effect size >0.01), medium (effect size >0.06), or large (effect size >0.14) (26).…”

Motor learning and transfer between real and virtual environments in young people with autism spectrum disorder: A prospective randomized cross over controlled trial

“…For the factor block, separate comparisons were made for acquisition (first acquisition block A1 vs. final acquisition block A4), retention (A4 vs. retention block R) and transfer (A4 vs. transfer block T). Partial eta‐squared ( η 2 ) was reported to measure effect size and interpreted as small (effect size >0.01), medium (effect size >0.06), or large (effect size >0.14) [Silva‐Filho et al, ]. Post hoc comparisons were carried out using the least significance difference test ( P < 0.05).…”

Newer rehabilitation therapies: strategies in chikungunya chronic arthralgia

“…1,2 Subsequently the guidance for pharmacological prophylaxis for a minimum of 7 days for medical inpatients who are at high risk has been challenged by haematologists both for effectiveness and cost effectiveness when the patient has been discharged before this course length has been completed. 3,4 In the last edition of Clinical Medicine, Thomas et al estimated the drug related costs of this aspect of the guidance for patients who would require ongoing prophylaxis post discharge, but they were unable to estimate the cost for district nursing support for those who could not self administer. 5 The Royal College of Physicians' Patient Safety Committee considered the implications of this element of the guidance in 2018 and concluded that the level of evidence was unclear and that implementation of the guidance across medical practice currently in the NHS did not include continuation of pharmacological prophylaxis post discharge.…”

“…1,2 Since chikungunya could be considered as a neglected tropical disease, potentially affecting over 1 billion people, additional supportive managements should also be investigated to establish more strategies to prevent arthralgia and increase functionality. [3][4][5] As in other rheumatic diseases, the recommended managements for chikungunya aim to prevent disability, unproductive work and secondary manifestations. [6][7][8] The chronic chikungunya arthralgia/arthritis symptoms suggests an immune mechanism to medication treatments, however the growing scientific evidences of physical rehabilitation improving functionality and quality of life should be more explored at the managements.…”

“…9,10 Moreover, two recent trials suggest novel approaches of rehabilitation therapies with transcranial direct current stimulation and pilates to reduce pain and improve functionality. 4,11 The long-term burden of persistent arthralgia negatively impacts the public health system, economically active people and quality of life. 10…”