Banca de DEFESA: LARISSA RAMALHO DANTAS VARELLA

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
STUDENT : LARISSA RAMALHO DANTAS VARELLA
DATE: 10/08/2020
TIME: 14:00
LOCAL: VIDEOCONFERÊNCIA
TITLE:

EFFECTS OF TRANSCRANIAL DIRECT CURRENT STIMULATION ON PAIN, SUB-MAXIMUM FUNCTIONAL CAPACITY AND STATE OF HUMOR IN WOMEN WITH PRIMARY DYSMENORRHEA

KEY WORDS:

Menstrual cycle. Pelvic pain. Chronic pain. Electrical Stimulation Therapy. Conservative treatment. Physiotherapy modalities

PAGES: 100
BIG AREA: Ciências da Saúde
AREA: Fisioterapia e Terapia Ocupacional
SUMMARY:

Introduction: Primary dysmenorrhea is a chronic condition that negatively affects women's lives in many social, emotional and physical aspects. So far, drug therapy and thermotherapy have been the most effective means of treating dysmenorrhea, but these have undesirable adverse reactions or short-term local effects. Transcranial direct current electrical stimulation (tDCS) is a non-invasive cortical stimulation technique that promotes changes in brain functioning, and seems to have good effects on pain and functionality. To date, there are no studies of this therapy on the dorsolateral prefrontal cortex in patients with primary dysmenorrhea. Objectives: The main objective is to investigate the effect of tDCS on the dorsolateral prefrontal cortex on pain, functionality, mood and anxiety in patients with primary dysmenorrhea. Secondary objectives include identifying, through a systematic review, the non-pharmacological resources used for the treatment of primary dysmenorrhea and establishing a protocol for the application of tDCS for the treatment of primary dysmenorrhea. Methods: Two studies were developed with different methods, a systematic review and a controlled, randomized, blinded clinical trial. For systematic review, searches were carried out in the databases, PubMed, LILACS, Ovid EMBASE, Scielo, CAPES, IBECS, SCOPUS, SCIENCE DIRECT, from March to October 2018. The studies published in the last 10 years were considered. Using the following combinations: “primary dysmenorrhea AND treatment” and “dysmenorrhea AND treatment”. Inclusion criteria were: clinical trials, presenting in the title and summary a non-pharmacological conservative therapeutic intervention approach for primary dysmenorrhea, having pain as the primary outcome, limiting or avoiding the use of the drug during the intervention, samples in humans, presenting quantitative analysis of ache. Studies were excluded if: the text was not written in English, Spanish or Portuguese, were duplicated in the databases and addressed secondary dysmenorrhea. The searches were carried out by two independent researchers and the articles were evaluated and identified initially by the title and later by the abstract. The selected studies underwent a methodological analysis using the PEDro scale, carried out by the two authors, individually. For the clinical trial, 26 volunteers with primary dysmenorrhea were randomized into two groups. The tDCS group received therapy for 5 consecutive days, while the Sham group performed the same protocol, but the current was turned on for a period of 30 seconds and then turned off. tDCS was performed in the dorsolateral prefrontal cortex, with an intensity of 2mA. Participants in both groups were assessed at two times: in the first 24 hours of the initial menstrual cycle (AV1), in the first 24 hours of the next menstrual cycle and after intervention (AV2). To evaluate the primary outcomes of pain and functionality, the numerical pain scale was used, respectively, and the 6-minute walk test was used for functionality. For the secondary outcomes, affectivity and anxiety, the positive and negative affect scale, the Hamilton anxiety rating scale, respectively. Results: In the systematic review, 14 eligible articles were identified, which addressed techniques of electroacupuncture, acupuncture, acupressure, auriculotherapy, transcutaneous electrical nerve stimulation, Yoga, isometric exercises, stretching, relaxation with diaphragmatic breathing, pelvic floor exercises and tissue massage for pain relief. In the clinical trial, no significant interaction between intervention and time was found in the NRS [F (2.44) = 1.358, p = 0.26] and a significant effect of time was noted [F (2.44) = 4.446, p = 0.01] was found. The active group showed a significant reduction in anxiety (p = 0.03) with a mean difference of 5.12 (95% CI 0.79 to 11.05). There were no significant differences between positive and negative affect (p = 0.95 and p = 0.15, respectively). Submaximal aerobic performance was significantly higher in the active group [F (2.21) = 5.591, p = 0.02], with a mean difference of 70.87 (95% CI 8.53 to 133.21). Conclusion: Until now, the techniques used to treat primary dysmenorrhea have positive effects on analgesia, with no apparent difference between them. They seem to be complementary to each other in the treatment of primary dysmenorrhea and have effects of little durability. tDCS in the dorsolateral prefrontal cortex region appears in this study as a resource with satisfactory effect on functionality. This is effective in reducing anxiety, improving mood and functionality. However, it has no significant direct effect on pain. The application of 2mA of direct current, for 20 minutes for 5 consecutive day sessions, presents a good result. However, it is suggested to analyze the possibility of alternating sessions to improve the clinical viability of the therapy.

 

BANKING MEMBERS:
Externa à Instituição - LICIA PAZZOTO CACCIARI - UDEM
Externo ao Programa - 4964489 - CLECIO GABRIEL DE SOUZA
Interna - 2212151 - ELIZABEL DE SOUZA RAMALHO VIANA
Externa à Instituição - KÁTIA KARINA DO MONTE SILVA - UFPE
Presidente - 2786809 - MARIA THEREZA ALBUQUERQUE BARBOSA CABRAL MICUSSI