Efeitos da neuroestimulação no tratamento da dor neuropática por traumatismo do plexo braquial

Abstract

Patients suffering from brachial plexus injury have a high prevalence of neuropathic pain. Due to the central component of the symptom and the increasing development of evidence about non-invasive neurostimulation techniques, it is supposed that these patients have one more opportunity for clinical treatment. The aim of the present study was to investigate whether rTMS and tDCS techniques are effective in the treatment of neuropathic pain in patients with brachial plexus trauma. Two articles were developed, the first one was a Systematic Review and the second was a Pilot Clinical Trial. The systematic review sought to identify research in pain that compared the efficacy of rTMS techniques applied to the motor cortex (M1) and dorsolateral prefrontal cortex (DLPF). It has been shown that high frequency rTMS applied to M1 and low frequency applied to right DLPF cortex can induce a diffuse and selective analgesic effect, with a significant effect for M1. The second article involved the evaluation of twenty individuals, randomly allocated in a treatment group and in a control group, who were submitted to blocks of 5 sessions of rTMS and anodal tDCS directed to M1. It has been found that both rTMS and tDCS are effective in reducing pain and secondary outcomes, with rTMS being superior, especially in reducing the intensity of paroxysmal pain and improving the multidimensional aspects of pain.