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Thibaut A, Shie VL, Ryan CM, Zafonte R, Ohrtman EA, Schneider JC, Fregni F. A review of burn symptoms and potential novel neural targets for non-invasive brain stimulation for treatment of burn sequelae. Burns 2021; 47:525-537. [PMID: 33293156 PMCID: PMC8685961 DOI: 10.1016/j.burns.2020.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 04/30/2020] [Accepted: 06/06/2020] [Indexed: 12/12/2022]
Abstract
Burn survivors experience myriad associated symptoms such as pain, pruritus, fatigue, impaired motor strength, post-traumatic stress, depression, anxiety, and sleep disturbance. Many of these symptoms are common and remain chronic, despite current standard of care. One potential novel intervention to target these post burn symptoms is transcranial direct current stimulation (tDCS). tDCS is a non-invasive brain stimulation (NIBS) technique that modulates neural excitability of a specific target or neural network. The aim of this work is to review the neural circuits of the aforementioned clinical sequelae associated with burn injuries and to provide a scientific rationale for specific NIBS targets that can potentially treat these conditions. We ran a systematic review, following the PRISMA statement, of tDCS effects on burn symptoms. Only three studies matched our criteria. One was a feasibility study assessing cortical plasticity in chronic neuropathic pain following burn injury, one looked at the effects of tDCS to reduce pain anxiety during burn wound care, and one assessed the effects of tDCS to manage pain and pruritus in burn survivors. Current literature on NIBS in burn remains limited, only a few trials have been conducted. Based on our review and results in other populations suffering from similar symptoms as patients with burn injuries, three main areas were selected: the prefrontal region, the parietal area and the motor cortex. Based on the importance of the prefrontal cortex in the emotional component of pain and its implication in various psychosocial symptoms, targeting this region may represent the most promising target. Our review of the neural circuitry involved in post burn symptoms and suggested targeted areas for stimulation provide a spring board for future study initiatives.
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Affiliation(s)
- Aurore Thibaut
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States; GIGA-Institute and Neurology Department, University of Liège and University Hospital of Liège, Liège, Belgium
| | - Vivian L Shie
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States
| | - Colleen M Ryan
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Shriners Hospitals for Children-Boston, Boston, MA, United States
| | - Ross Zafonte
- Massachusetts General Hospital and Brigham and Women's Hospital, Boston, United States
| | - Emily A Ohrtman
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States.
| | - Felipe Fregni
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States.
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Ohrtman EA, Zaninotto AL, Carvalho S, Shie VL, Leite J, Ianni CR, Kazis LE, Zafonte R, Ryan CM, Schneider JC, Fregni F. Longitudinal Clinical Trial Recruitment and Retention Challenges in the Burn Population: Lessons Learned From a Trial Examining a Novel Intervention for Chronic Neuropathic Symptoms. J Burn Care Res 2019; 40:792-795. [DOI: 10.1093/jbcr/irz084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Abstract
Long-term trials are key to understanding chronic symptoms such as pain and itch. However, challenges such as high attrition rates and poor recruitment are common when conducting research. The aim of this work was to explore these issues within a long-term randomized control trial using transcranial direct current stimulation to treat pain and itch. This parallel double blinded, placebo-controlled randomized trial was comprised of 15 transcranial direct current stimulation visits and 7 follow-up visits. Participants were over the age of 18, had a burn injury that occurred at least 3 weeks before enrollment, and reported having pain and/or itch that was moderate to severe in intensity. A total of 31 subjects were randomized into either an active or sham transcranial direct current stimulation groups. There were no significant differences between the groups in terms of age, race, education, baseline depression, or anxiety. The median dropout time was at visit 19 (visit 16 [SE = 1.98] for the sham group and visit 19 [SE = 1.98] for the active group). Analysis showed no differences in the dropout rate between groups [χ2(1) = 0.003, P = .954]. The dropout rate was 46.7% for the sham group and 43.8% for the active group. Overall, 45.2% of the subjects dropped out of the trial. Long-term clinical trials are an essential part of evaluating interventions for symptoms such as chronic pain and itch. However, as seen in this trial, long-term studies in the burn population often face recruitment and adherence challenges.
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Affiliation(s)
- Emily A Ohrtman
- Department of Physical Medicine and Rehabilitation, Boston-Harvard Burn Injury Model System, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ana Luiza Zaninotto
- Department of Physical Medicine and Rehabilitation, Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sandra Carvalho
- Neurotherapeutics and Experimental Psychopathology (NEP) Group, Psychological Neuroscience Lab, CiPsi, School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
| | - Vivian L Shie
- Department of Physical Medicine and Rehabilitation, Boston-Harvard Burn Injury Model System, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jorge Leite
- Universidade Portucalense, Portucalense Institute for Human Development – INPP, Oporto, Portugal
| | - Corinne Rose Ianni
- Department of Physical Medicine and Rehabilitation, Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lewis E Kazis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Ross Zafonte
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Colleen M Ryan
- Massachusetts General Hospital, Shriners Hospitals for Children, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
- Neurotherapeutics and Experimental Psychopathology (NEP) Group, Psychological Neuroscience Lab, CiPsi, School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
| | - Felipe Fregni
- Department of Physical Medicine and Rehabilitation, Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
- Neurotherapeutics and Experimental Psychopathology (NEP) Group, Psychological Neuroscience Lab, CiPsi, School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
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Schneider JC, Shie VL, Espinoza LF, Shapiro GD, Lee A, Acton A, Marino M, Jette A, Kazis LE, Ryan CM. Impact of Work-Related Burn Injury on Social Reintegration Outcomes: A Life Impact Burn Recovery Evaluation (LIBRE) Study. Arch Phys Med Rehabil 2017; 101:S86-S91. [PMID: 29183751 DOI: 10.1016/j.apmr.2017.10.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/19/2017] [Accepted: 10/22/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine differences in long-term social reintegration outcomes for burn survivors with and without work-related injuries. DESIGN Cross-sectional survey. SETTING Community-dwelling burn survivors. PARTICIPANTS Burn survivors (N=601) aged ≥18 years with injuries to ≥5% total body surface area or burns to critical areas (hands, feet, face, or genitals). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The Life Impact Burn Recovery Evaluation Profile was used to examine the following previously validated 6 scale scores of social participation: Family and Friends, Social Interactions, Social Activities, Work and Employment, Romantic Relationships, and Sexual Relationships. RESULTS Older participants, those who were married, and men were more likely to be burned at work (P<.01). Burn survivors who were injured at work scored significantly lower on the Work and Employment scale score after adjusting for demographic and clinical characteristics (P=.01). All other domain scale scores demonstrated no significant differences between groups. Individuals with work-related injuries scored significantly worse on 6 of the 19 items within the Work and Employment scale (P<.05). These individuals were more likely to report that they were afraid to go to work and felt limited in their ability to perform at work. CONCLUSIONS Burn survivors with work-related injuries report worse work reintegration outcomes than those without work-related injuries. Identification of those at higher risk for work reintegration challenges after burn injury may enable survivors, providers, employers, and insurers to better use appropriate resources to promote and target optimal employment outcomes.
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Affiliation(s)
| | - Vivian L Shie
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
| | - Leda F Espinoza
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Gabriel D Shapiro
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Austin Lee
- Department of Mathematical Sciences, Bentley University, Waltham, MA
| | - Amy Acton
- Phoenix Society for Burn Survivors, Grand Rapids, MI
| | - Molly Marino
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
| | - Alan Jette
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
| | - Lewis E Kazis
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
| | - Colleen M Ryan
- Massachusetts General Hospital, Shriners Hospitals for Children-Boston, Harvard Medical School, Boston, MA
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Miraval FK, Shie VL, Morales-Quezada L, Santiago C, Fernandes-Marcondes B, Nadler D, Ryan CM, Schneider JC, Fregni F. A Preliminary Study on qEEG in Burn Patients With Chronic Pruritus. Ann Rehabil Med 2017; 41:693-700. [PMID: 28971055 PMCID: PMC5608678 DOI: 10.5535/arm.2017.41.4.693] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 11/20/2015] [Indexed: 11/05/2022] Open
Abstract
Objective To explore and determine the reorganizational changes in the cortical neural circuits associated with pruritis, this study was undertaken to compare the electroencephalography (EEG) changes in burn patients having primary symptoms of chronic itching (pruritis) and their paired healthy subjects. Methods Eight subjects were recruited for this exploratory pilot study: 4 patients with pruritus after burn injury matched by gender and age with 4 healthy subjects. EEG recordings were analyzed for absolute alpha, low beta, high beta, and theta power for both groups. Results The mean age of the burn patients was 41.75 years; while the mean age for the matched healthy subjects was 41.5 years. All subjects were male. A decreased alpha activity was observed in the occipital channels (0.82 vs. 1.4; p=0.01) and a decreased low beta activity in the frontal area (0.22 vs. 0.4; p=0.049) in eyes closed conditions. An overall decreased theta trend was observed in both the eyes open and eyes closed conditions in burn patients, compared to healthy individuals. Conclusion This preliminary study presents initial evidence that chronic pruritus in burn subjects may be associated with brain reorganizational changes at the cortical level characterized by an EEG pattern.
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Affiliation(s)
- Fiorella K Miraval
- Spaulding Center of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Vivian L Shie
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Leon Morales-Quezada
- Spaulding Center of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Bianca Fernandes-Marcondes
- Spaulding Center of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Deborah Nadler
- Spaulding Center of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Colleen M Ryan
- Surgical Services, Sumner M. Redstone Burn Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Shriners Hospitals for Children-Boston, Boston, MA, USA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Felipe Fregni
- Spaulding Center of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
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Gerrard P, Kazis LE, Ryan CM, Shie VL, Holavanahalli R, Lee A, Jette A, Fauerbach JA, Esselman P, Herndon D, Schneider JC. Validation of the Community Integration Questionnaire in the adult burn injury population. Qual Life Res 2015; 24:2651-5. [DOI: 10.1007/s11136-015-0997-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2015] [Indexed: 11/25/2022]
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