1PhD candidate of Nursing, Department of Medical-Surgical Nursing, Faculty of Nursing & Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
2MS in Nursing, School of Nursing & Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
3Assistant professor of General surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
4PhD of Nursing, Department of Medical-Surgical Nursing, School of Nursing & Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
5PhD candidate in Cognitive Neurosciences, Faculty of Educative Sciences and Psychology, Tabriz University
Background: Pain is of stressful and unpleasant procedures after daily dressing of burn wound, so that if the burn pain is not alleviated properly, it can cause harmful effects other than discomfort. There is evidence that cathodal stimulation of somatosensory cortex can be effective in relieving acute pain. Aim: The main purpose of this study was to determine the effect of Direct Transcranial Current Stimulation on the intensity of burn dressing pain. Methods: To conduct this randomized two-group clinical trial , 60 eligible patients who had been hospitalized in burn department of Imam Reza (AS) hospital of Mashhad were enrolled through the convenience sampling and randomly divided into the control (n=30) and intervention (n=30) groups by stratification method. Patients in the intervention group received cathodal stimulation of somatosensory cortex for 20 minutes with one mA current intensity before dressing; while thetDCS device was turned off after 30 seconds of stimulation in the control group. The standard visual analog scale of pain was performed immediately before intervention, as well as before and after wound dressing. Results: In the intervention group, 76.7% (n=23) of cases were male while in control group 46.7% (n=14) of patients were female. Mann-Whitney test showed no significant difference between the intervention (1.7±2.0) and control (1.0±0.9) groups in terms of pain intensity before intervention (P=0.46). Independent t-test showed that pain intensity in the intervention group (6.4±1.9) versus control (7.9±1.5) was significantly different after burn dressing (P<0.001). Conclusion: Applying tDCS can be an effective intervention for decreasing pain associated with burn dressing.
1. Carrougher GJ, Ptacek JT, Honari S, Schmidt AE, Tininenko JR, Gibran NS, et al. Self-Reports of Anxiety in Burn-injured Hospitalized Adults During Routine Wound Care. J Burn Care Res. 2006;27(5):676-81.
2. Black JM, Hawks JH. Medical-Surgical Nursing: Clinical Management for Positive Outcomes, 8th ed. Philadelphia: Elsevier/Saunders; 2009.
3. Smeltzer SC, Bare BB, Hinkle JL, Cheever KH. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 12th ed. Philadelphia: Lippincott Williams & Wilkins; 2010.
4.Najafi Anari H, Rostampour M. Evaluation of New Methods for Treatment of Skin Burns in Children, with Emphasis on the Role of Nursing Care. Proceedings of 21th International Congress of Pediatrics; Imam Khomeini Hospital, Tehran, Iran. p. 70. (Persian)
6. Wiechman Askay S, Patterson DR. What are the Psychiatric Sequelae of Burn Pain? Curr Pain Headache Rep. 2008;12(2):94-7.
7. Antal A, Brepohl N, Poreisz C, Boros K, Csifcsak G, Paulus W. Transcranial Direct Current Stimulation over Somatosensory Cortex Decreases Experimentally Induced Acute Pain Perception. Clin J Pain. 2008;24(1):56-63.
8. Frenay M-C, Faymonville M-E, Devlieger S, Albert A, Vanderkelen A. Psychological Approaches During Dressing Changes of Burned Patients: a Prospective Randomised Study Comparing Hypnosis Against Stress Reducing Strategy. Burns. 2001;27(8):793-9.
9. Latarjet J, Choinere M. Pain in Burn Patients. Burns. 1995;21(5):344-8.
11. Brigham PA. American Burn Association Fact Sheet: Burn Incidence and Treatment in the United States. Chicago,IL, American Burn Association; 2000.
12. Ashburn MA. Burn Pain: the Management of Procedure-Related Pain. J Burn Care Rehabil. 1995;16(3 Pt 2):365-71.
13.Tournaire M, Theau-Yonneau A. Complementary and Alternative Approaches to Pain Relief During Labor. Evid Based Complement Alternat Med: eCAM. 2007;4(4):409-17.
14. Summer GJ, Puntillo KA, Miaskowski C, Green PG, Levine JD. Burn Injury Pain: the Continuing Challenge. J Pain. 2007;8(7):533-48.
15. Esselman PC, Thombs BD, Magyar-Russell G, Fauerbach JA. Burn Rehabilitation: State of the Science. Am J Phys Med Rehabil. 2006;85(4):383-413.
16. Rafii F, Mohammadi Fakhar F, Jamshidi Orak R, Inanloo M. Effect of Jaw Relaxation on Pain Intensity of Burn Dressing. IJCCN. 2010;3(2):51-6. (Persian).
17. Clark VP, Coffman BA, Trumbo MC, Gasparovic C. Transcranial Direct Current Stimulation (tDCS) Produces Localized and Specific Alterations in Neurochemistry: A 1H Magnetic Resonance Spectroscopy Study. Neurosci Lett. 2011;500:67–71.
18. Knotkova H, Cruciani R. Non-invasive Transcranial Direct Current Stimulation for the Study English and Treatment of Neuropathic Pain. Methods Mol Biol. 2010;617:505-15.
19. George MS, Nahas Z, Kozol FA, Li X, Yamanaka K, Mishory A, et al. Mechanisms and the Current State of Transcranial Magnetic Stimulation. CNS Spectr. 2003;8(7):496-514.
20. Borckardt JJ, Romagnuolo J, Reeves ST, Madan A, Frohman H, Beam W, et al. Feasibility, Safety, and Effectiveness of Transcranial Direct Current Stimulation for Decreasing Post-ERCP Pain: a Randomized, Sham-Controlled, Pilot Study. Gastrointest Endosc. 2011;73(6):1158-64.
21. Borckardt JJ, Reeves ST, Robinson SM, May JT, Epperson TI, Gunselman RJ, et al. Transcranial Direct Current Stimulation (tDCS) Reduces Postsurgical Opioid Consumption in Total Knee Arthroplasty (TKA). Clin J Pain. 2013;29(11):925-8.
22. Antal AP, Paulus W. Investigating Neuroplastic Changes in the Human Brain Induced by Transcranial Direct Current Stimulation (tDCS) and Alternating Current (tACS) Stimulation Methods. Clin EEG Neurosci. 2012; 43(3):175.
23. Mahmoudi H, Borhani Haghighi A, Petramfar P, Jahanshahi S, Salehi Z, Fregni F. Transcranial Direct Current Stimulation: Electrode Montage in Stroke. Disabil Rehabil. 2011;33(15-16):1383-8.
24. Zandieh A, Parhizgar SE, Fakhri M, Taghvaei M, Miri S, Shahbabaie A, et al. Modulation of Cold Pain Perception by Transcranial Direct Current Stimulation in Healthy Individuals. Neuromodulation : Neuromodulation. 2013;16(4):345-8.
25. Gift AG. Visual Analogue Scales: Measurement of Subjective Phenomena. Nurs Res. 1989;38(5):286-8.
26. Gallagher EJ, Bijur PE, Latimer C, Silver W. Reliability and Validity of a Visual Analog Scale for Acute Abdominal Pain in the ED. Am J Emerg Med. 2002;20(4):287-90.
27. Friesner SA, Curry DM, Moddeman GR. Comparison of Two Pain-Management Strategies During Chest Tube Removal: Relaxation Exercise With Opioids and Opioids Alone. Heart Lung. 2006;35(4):269-76.
28. shakibai F, Samui R, Salehi P. The Effectiveness of Hypnosis on Pain of Burns: a Controlled Clinical Trial. JRMS. 2000;7(1):48-50. (Persian)
29. Motevaseleian, M. and K. Dehghani, The Effect of Massage on Pain and Anxiety of Burn Pateint. SSUMS, 2001; 11(3):7-12. (Persian)
30. Ziegler EA, Magerl W, Meyer RA, Treede RD. Secondary Hyperalgesia to Punctate Mechanical Stimuli. Central Sensitization to A-Fibre Nociceptor Input. Brain. 1999;122 (12):2245-57.
31. Esfahlan AJ, Lotfi M, Zamanzadeh V, Babapuor J. Burn Pain and Patients’ Responses. Burns. 2010;36(7):1129-33.
32. Richardson P, Mustard L. The Management of Pain in the Burns Unit. Burns. 2009;35(7):921-36.
33. Byers JF, Bridges S, Kijek J, LaBorde P. Burn Patients' Pain and Anxiety Experiences. J Burn Care Rehabil. 2001;22(2):144-9.
34. Manzari ZS, Memarian R, Vanaki Z. Relationship Between Pain and Anxiety in Burn Patients. JBUMS. 2007;14(2):45-50. (Persian)
35. Taal LA, Faber AW. Post-Traumatic Stress, Pain and Anxiety in Adult Burn Victims. Burns : Burns. 1997;23(7-8):545-9.
36. Bindman LJ, Lippold OC, Redfearn JW. The Action of Brief Polarizing Currents on the Cerebral Cortex of the Rat (1) During Current Flow and (2) in the Production of Long-Lasting after-Effects. Physiol J. 1964;172:369-82.
37. Creutzfeldt OD, Fromm GH, Kapp H. Influence of Transcortical d-c Currents on Cortical Neuronal Activity. Experimental neurology. 1962;5:436-52.
38. Purpura DP, McMurtry JG. Intracellular Activities and Evoked Potential Changes during Polarization of Motor Cortex. J Neurophysiol. 1965;28:166-85.
39. Nitsche MA, Nitsche MS, Klein CC, Tergau F, Rothwell JC, Paulus W. Level of Action of Cathodal DC Polarisation Induced Inhibition of the Human Motor Cortex. Clinical neurophysiology: Clin Neurophysiol. 2003;114(4):600-4.
40. Paulus W. Outlasting Excitability Shifts Induced by Direct Current Stimulation of the Human Brain. Suppl Clin Neurophysiol. 2004;57:708-14.
41. Edwards RR, Smith MT, Klick B, Magyar-Russell G, Haythornthwaite JA, Holavanahalli R, et al. Symptoms of Depression and Anxiety as Unique Predictors of Pain-Related Outcomes Following Burn Injury. Ann Behav Med. 2007;34(3):313-22.
42. Edwards RR, Magyar-Russell G, Thombs B, Smith MT, Holavanahalli RK, Patterson DR, et al. Acute Pain at Discharge from Hospitalization is a Prospective Predictor of Long-Term Suicidal Ideation after Burn Injury. Arch Phys Med Rehabil. 2007;88(12):36-42.