title: Feasibility, safety, and effectiveness of transcranial direct current stimulation for decreasing post-ERCP pain: a randomized, sham-controlled, pilot study.
abstract: BACKGROUND
  Emerging evidence shows that transcranial direct current stimulation (tDCS), a minimally invasive brain stimulation technique, has analgesic effects in chronic pain patients and in healthy volunteers with experimental pain. No studies have examined the analgesic effects of tDCS immediately after surgical/endoscopic procedures. Endoscopy investigating abdominal pain, especially ERCP, can cause significant postprocedural pain.
  
  
  OBJECTIVE
  To test the feasibility, efficacy, and safety of tDCS on post-ERCP pain and analgesia use.
  
  
  METHODS
  Randomized, sham-controlled, pilot study.
  
  
  METHODS
  Tertiary-care medical center.
  
  
  METHODS
  This study involved 21 patients who were hospitalized overnight for ERCP for unexplained right upper quadrant pain.
  
  
  METHODS
  Twenty minutes of real 2.0 mA tDCS or sham (anode over left prefrontal cortex; cathode over gut-representation of right sensory cortex) immediately after ERCP.
  
  
  METHODS
  Pain (visual analogue scale, McGill pain questionnaire, brief pain inventory), patient-controlled analgesia use, adverse events.
  
  
  RESULTS
  Real tDCS was associated with 22% less total hydromorphone use, versus sham. The slope of the cumulative patient-controlled analgesia usage curve was significantly steeper in the sham tDCS group (F [2,13] = 15.96; P = .0003). Real tDCS patients reported significantly less pain interference with sleep (t [17] = 3.70; P = .002) and less throbbing pain (t [16] = 2.37; P = .03). Visual analogue scale pain and mood scores (4 hours post-ERCP) suggested a nonsignificant advantage for real tDCS, despite less hydromorphone use. Side effects of tDCS were limited to mild, self-limited tingling, itching, and stinging under electrodes.
  
  
  CONCLUSIONS
  Small sample size, variability in chronic pain, and chronic opioid use.
  
  
  CONCLUSIONS
  In this pilot study, tDCS appears to be safe, has minimal side effects, and may reduce postprocedural analgesia requirements and subjective pain ratings. Future studies appear warranted.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina 29425, USA. borckard@musc.edu
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Borckardt
authors.forename: Joseph
authors.initials: J
authors.lastname: Romagnuolo
authors.forename: Scott T
authors.initials: ST
authors.lastname: Reeves
authors.forename: Alok
authors.initials: A
authors.lastname: Madan
authors.forename: Heather
authors.initials: H
authors.lastname: Frohman
authors.forename: Will
authors.initials: W
authors.lastname: Beam
authors.forename: Mark S
authors.initials: MS
authors.lastname: George
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000628:therapy*; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D004599:Electric Stimulation Therapy / Q000379:methods*; D004566:Electrodes; D005260:Female; D006801:Humans; D004091:Hydromorphone / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010865:Pilot Projects; D012720:Severity of Illness Index; D013003:Somatosensory Cortex; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D004091:Hydromorphone