Abstract
BackgroundSubacromial pain syndrome (SAPS) is a common complaint in orthopaedics. Subacromial corticosteroid injections (CSI) can relieve pain in the short term. Anodal transcranial direct current stimulation (a-tDCS) has been used for symptomatic pain relief in a variety of chronic pain conditions. The aim of this pilot study was to assess whether the application a-tDCS could enhance the symptomatic relief provided by CSI in patients affected by SAPS.MethodsThirty-eight participants (18 to 65-year-old) suffering from SAPS were recruited to have a CSI and randomly allocated to receive, 1 weeks post CSI, real a-tDCS (r-tDCS), sham tDCS (s-tDCS) or no intervention (Control). Upper limb function was measured 1 week prior to the CSI, at the 2- and 4-week follow-ups using self-administered questionnaires and physical measures. Self-reported pain and activity during each day were logged by the participants using visual analog scales (VAS). Differences between groups were tested using repeated-measures ANOVAs.ResultsPain VAS and the Single Assessment Numeric Evaluation scale (SANE) showed significant improvement from baseline 2 weeks and 4 weeks after CSI in all groups (p < 0.05). There were no significant group X time interaction 2 weeks following tDCS treatment in any of the variables.ConclusionAll groups showed significant improvement in pain VAS and SANE scores following the CSI. One session of a-tDCS treatment 2 weeks following CSI did not result in any additive or potentializing effects when compared to a s-tDCS or a control group.Trial registrationClinicalTrials.gov, NCT03967574. Registered 30 May 2019 - Retrospectively registered.
Highlights
Subacromial pain syndrome (SAPS) is a common complaint in orthopaedics
Further pain relief can be obtained with subacromial corticosteroid injection (CSI) which acts by reducing the inflammatory response around the tendons
There were no significant differences between the three arms in baseline socio-demographic characteristics, questionnaire scores, strength, range of motion, or daily activity (See Tables 2 and 3)
Summary
Subacromial pain syndrome (SAPS) is a common complaint in orthopaedics. Subacromial corticosteroid injections (CSI) can relieve pain in the short term. Newer types injectable products, such a Platelet-Rich-Plasma (PRP) and hyaluronic acid, have shown mixed results in comparison to CSI [14,15,16,17,18]. At this time a positive response to CSI, defined as a reduction in pain and improvement in function assessed by the patient, is still considered an important prognostic factor that can guide the surgeon regarding the suitability of bursectomy or acromioplasty, a surgical treatment for persistent SAPS [19]
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