title: Motor/Prefrontal Transcranial Direct Current Stimulation (tDCS) Following Lumbar Surgery Reduces Postoperative Analgesia Use.
abstract: METHODS
  Randomized, controlled pilot trial.
  
  
  OBJECTIVE
  The present study is the first randomized, double-blind, sham-controlled pilot clinical trial of transcranial direct current stimulation (tDCS) for pain and patient-controlled analgesia (PCA) opioid usage among patients receiving spine surgery.
  
  
  BACKGROUND
  Lumbar spinal surgeries are common, and while pain is often a complaint that precedes surgical intervention, the procedures themselves are associated with considerable postoperative pain lasting days to weeks. Adequate postoperative pain control is an important factor in determining recovery and new analgesic strategies are needed that can be used adjunctively to existing strategies potentially to reduce reliance on opioid analgesia. Several novel brain stimulation technologies including tDCS are beginning to demonstrate promise as treatments for a variety of pain conditions.
  
  
  METHODS
  Twenty-seven patients undergoing lumbar spine procedures at Medical University of South Carolina were randomly assigned to receive four 20-minute sessions of real or sham tDCS during their postsurgical hospital stay. Patient-administered hydromorphone usage was tracked along with numeric rating scale pain ratings.
  
  
  RESULTS
  The effect of tDCS on the slope of the cumulative PCA curve was significant (P < 0.001) and tDCS was associated with a 23% reduction in PCA usage. In the real tDCS group a 31% reduction was observed in pain-at-its-least ratings from admission to discharge (P = 0.027), but no other changes in numeric rating scale pain ratings were significant in either group.
  
  
  CONCLUSIONS
  The present pilot trial is the first study to demonstrate an opioid sparing effect of tDCS after spine surgical procedures. Although this was a small pilot trial in a heterogeneous sample of spinal surgery patients, a moderate effect-size was observed for tDCS, suggesting that future work in this area is warranted.
  
  
  METHODS
  2.
authors.affiliation: *Department of Orthopedic Surgery, Medical University of South Carolina, Charleston, SC †Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC ‡Menninger Clinic and Baylor College of Medicine, Houston, TX §Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC ¶Ralph H. Johnson VAMC, Charleston SC.
authors.forename: John
authors.initials: J
authors.lastname: Glaser
authors.forename: Scott T
authors.initials: ST
authors.lastname: Reeves
authors.forename: William David
authors.initials: WD
authors.lastname: Stoll
authors.forename: Thomas I
authors.initials: TI
authors.lastname: Epperson
authors.forename: Megan
authors.initials: M
authors.lastname: Hilbert
authors.forename: Alok
authors.initials: A
authors.lastname: Madan
authors.forename: Mark S
authors.initials: MS
authors.lastname: George
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Borckardt
mesh_terms: D000368:Aged; D016058:Analgesia, Patient-Controlled / Q000379:methods* / Q000639:trends; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology*; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D010865:Pilot Projects; D017397:Prefrontal Cortex / Q000502:physiology*; D065908:Transcranial Direct Current Stimulation / Q000379:methods* / Q000639:trends; D016896:Treatment Outcome