Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Sep 27;10:466.
doi: 10.3389/fnhum.2016.00466. eCollection 2016.

Feasibility of Non-invasive Brain Modulation for Management of Pain Related to Chemoradiotherapy in Patients With Advanced Head and Neck Cancer

Affiliations
Free PMC article

Feasibility of Non-invasive Brain Modulation for Management of Pain Related to Chemoradiotherapy in Patients With Advanced Head and Neck Cancer

Xiao-Su Hu et al. Front Hum Neurosci. .
Free PMC article

Abstract

Patients with head and neck cancer often experience a significant decrease in their quality of life during chemoradiotherapy (CRT) due to treatment-related pain, which is frequently classified as severe. Transcranial direct current stimulation (tDCS) is a method of non-invasive brain stimulation that has been frequently used in experimental and clinical pain studies. In this pilot study, we investigated the clinical impact and central mechanisms of twenty primary motor cortex (M1) stimulation sessions with tDCS during 7 weeks of CRT for head and neck cancer. From 48 patients screened, seven met the inclusion criteria and were enrolled. Electroencephalography (EEG) data were recorded before and after tDCS stimulation as well as across the trial to monitor short and long-term impact on brain function. The compliance rate during the long trial was extremely high (98.4%), and patients mostly reported mild side effects in line with the literature (e.g., tingling). Compared to a large standard of care study from our institution, our initial results indicate that M1-tDCS stimulation has a pain relief effect during the CRT that resulted in a significant attenuation of weight reduction and dysphagia normally observed in these patients. These results translated to our patient cohort not needing feeding tubes or IV fluids. Power spectra analysis of EEG data indicated significant changes in α, β, and γ bands immediately after tDCS stimulation and, in addition, α, δ, and θ bands over the long term in the seventh stimulation week (p < 0.05). The independent component EEG clustering analysis showed estimated functional brain regions including precuneus and superior frontal gyrus (SFG) in the seventh week of tDCS stimulation. These areas colocalize with our previous positron emission tomography (PET) study where there was activation in the endogenous μ-opioid system during M1-tDCS. This study provides preliminary evidence demonstrating the feasibility and safety of M1-tDCS as a potential adjuvant neuromechanism-driven analgesic therapy for head and neck cancer patients receiving CRT, inducing immediate and long-term changes in the cortical activity and clinical measures, with minimal side-effects.

Keywords: EEG; adjuvant; chemotherapy; head and neck cancer; pain management; tDCS.

Figures

Figure 1
Figure 1
Study Protocol (* denotes simultaneous stimulation and EEG recording).
Figure 2
Figure 2
tDCS Stimulation and EEG recording setup. (A) M1-PFC tDCS set up with concurrent EEG. (B) Electric current pathway from M1 anode in red to PFC cathode in blue. (C) tDCS anode/cathode and EEG channel locations set up.
Figure 3
Figure 3
EEG signal sources changes to PFC and PreCuneus following 7 weeks of tDCS stimulation. The estimated locations of the EEG sources are marked out for each stage. The blue, red, and yellow dots indicate, respectively, the sources with possible locations at SFG, PreCuneus, and other areas. (A) Estimated signal sources before tDCS stimulation (average of week 2, 3, and 7). (B) Estimated signal sources immediately after tDCS stimulation (average of week 2, 3, and 7). (C) Estimated signal sources in pre-study visit week. (D) Estimated signal sources in week seven. (E) Estimated tDCS-induced mu-opioid activation locations (DosSantos et al., 2014).
Figure 4
Figure 4
EEG power spectra analysis results comparison for all channels before and immediately after tDCS stimulation (1 - 50 Hz; Fp1, Fp2, Fz, F3, Cz, and P3; average of week 2, 3, and 7). The background colors indicate EEG frequency bands: red, δ wave; orange, θ wave; yellow, α wave; green, β wave; blue, γ wave. The green and blue lines, respectively, indicate power spectra before and after tDCS stimulation. Generally the power decreased immediately after tDCS stimulation for α, β, and γ waves.
Figure 5
Figure 5
EEG power spectra analysis results comparison for all channels in the pre-study visit week and seventh week (1–50 Hz; Fp1, Fp2, Fz, F3, Cz, and P3). The background colors indicate the EEG frequency bands: red, δ wave; orange, θ wave; yellow, α wave; green, β wave; blue, γ wave. The green lines and blue lines, respectively, indicate power spectra in the seventh week and pre-visit week of tDCS stimulation. Generally the power of δ, θ, α, and β waves increased, while the power of γ wave decreased in channels Fp1/Fp2/P3 and increased in channels F3/Fz/Cz, after 7 weeks of tDCS stimulation.
Figure 6
Figure 6
Intraoral Pain Area and Intensity During Chemoradiation/tDCS trial. All four patients reported only mild-to-moderate pain throughout their 7-week course of CRT. Using the GeoPain technology (MoxyTech LLC, MI), patients are able to quickly and efficiently illustrate their pain locations and pain intensity, allowing healthcare providers to both acknowledge current pain, as well as easily access and evaluate the patients pain history.

Similar articles

See all similar articles

Cited by 2 articles

References

    1. Argiris A., Li Y., Forastiere A. (2004). Prognostic factors and long-term survivorship in patients with recurrent or metastatic carcinoma of the head and neck. Cancer 101, 2222–2229. 10.1002/cncr.20640 - DOI - PubMed
    1. Boggio P. S., Zaghi S., Lopes M., Fregni F. (2008). Modulatory effects of anodal transcranial direct current stimulation on perception and pain thresholds in healthy volunteers. Eur. J. Neurol. 15, 1124–1130. 10.1111/j.1468-1331.2008.02270.x - DOI - PubMed
    1. Borckardt J. J., Reeves S. T., Frohman H., Madan A., Jensen M. P., Patterson D., et al. . (2011). Fast left prefrontal rTMS acutely suppresses analgesic effects of perceived controllability on the emotional component of pain experience. Pain 15, 182–187. 10.1016/j.pain.2010.10.018 - DOI - PMC - PubMed
    1. Bromm B., Lorenz J. (1998). Neurophysiological evaluation of pain. Electroencephalogr. Clin. Neurophysiol. 107, 227–253. 10.1016/S0013-4694(98)00075-3 - DOI - PubMed
    1. Capuano G., Grosso A., Gentile P. C., Battista M., Bianciardi F., Di Palma A., et al. . (2008). Influence of weight loss on outcomes in patients with head and neck cancer undergoing concomitant chemoradiotherapy. Head Neck 30, 503–508. 10.1002/hed.20737 - DOI - PubMed
Feedback