A review of burn symptoms and potential novel neural targets for non-invasive brain stimulation for treatment of burn sequelae

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.

Scrambler Therapy for Chronic Pain after Burns and Its Effect on the Cerebral Pain Network: A Prospective, Double-Blinded, Randomized Controlled Trial

“…Hosseini et al reported that modulation of the sensory cortex with transcranial direct current stimulation reduced pain and anxiety during burn scar treatment [ 41 ]. A review article also indicated that changes in cerebral activation during non-invasive brain stimulation were associated with improvements in pain symptoms, pruritus, depression, and sleep disturbances caused by burns [ 42 ].…”

Analgesia en el paciente quemado.

“…Se ha documentado la reducción de dolor, mejora en la función motora y las capacidades cognitivas y como tratamiento de la depresión. Actualmente, la información científica sobre esto se encuentra muy reducida en la literatura y se requieren más estudios para conocer con amplitud sus beneficios sobre dolor en estos pacientes (15).…”

Reorganization of cerebellar cortex structural components one day after experimental thermal injury

“…The skin is the first to be damaged by the action of an exogenous burn factor, and secondary changes occur in all body systems [13,15]. At thermal defeat, there is a neuro-pain syndrome, and also emergence in blood plasma of burn toxins, peptides of average molecular weight which provoke development of endogenous intoxication and cause disturbances of blood circulation and morphological reorganization of neuroendocrine bodies, in particular, a cerebellum which is a target under the influence of factors of different origin [4,14]. This organ of the central nervous system is a multifunctional component of the brain, which is responsible not only for motor control, but participates in cognitive functions, afferent and behavioral reactions, the dynamics of emotional and mental state, their changes [3,19].…”