Efficacy of Transcranial Direct-Current Stimulation in Women With Provoked Vestibulodynia

Morin, A.; Léonard, Guillaume; Gougeon, Véronique; Cyr, Marie-Pierre; Waddell, Guy; Bureau, Yves-André; Girard, Isabelle; Morin, Mélanie

doi:10.1097/01.ogx.0000521121.90909.ff

Cited by 4 publications

(6 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Three of these studies did not randomly allocate participants to groups (Cummiford 2016; Lindholm 2015; Yoon 2014). Six were not clearly in a chronic population (Bolognini 2015; Choi 2014; Khedr 2005; Ma 2015; Morin 2017; Schabrun 2014), two were not studies of electrical brain stimulation (Maestu 2013; Smania 2005), one did not employ a sham control (Seada 2013).…”

Section: Resultsmentioning

confidence: 99%

“…May not be exclusively chronic painBelci 2004Pain is not measured as an outcomeBolognini 2013Inclusion of acute and chronic pain patientsBolognini 2015Not clearly a chronic populationCarraro 2010Not a study of electrical brain stimulationChoi 2012bStudy of acute painChoi 2012aStudy of acute painChoi 2014Not clearly a chronic populationCummiford 2016Allocation not randomisedEvtiukhin 1998A study of postoperative pain. No sham control employedFrentzel 1989Not a study of brain stimulationHargrove 2012bUncontrolled long‐term follow‐up data from Hargrove 2012aJohnson 2006Self‐reported pain is not measuredKatz 1991Study not confined to chronic painKhedr 2015Not clearly a chronic populationLindholm 2015Allocation not randomisedLongobardi 1989Not clearly studying chronic painMa 2015Not clearly a chronic populationMaestu 2013Not electrical brain stimulation ‐ magnetic fields unlikely to induce electrical currentsMorin 2017Not clearly a chronic pain population ‐ provoked vestibulodyniaNelson 2010Intervention not designed to alter cortical activity directly by electrical stimulation ‐ a neuro feedback interventionO'Connell 2013Not a RCT or quasi‐RCT ‐ no randomisation specifically to treatment group or orderPujol 1998Participants are a mixture of acute and chronic pain patientsSchabrun 2014Not clearly a chronic populationSeada 2013No sham control employed…”

Section: Characteristics Of Excluded Studies [Ordered By Study Id]mentioning

confidence: 99%

See 1 more Smart Citation

Non-invasive brain stimulation techniques for chronic pain

O’Connell

Marston

Spencer

et al. 2018

Cochrane Database of Systematic Reviews

105

View full text Add to dashboard Cite

Background This is an updated version of the original Cochrane Review published in 2010, Issue 9, and last updated in 2014, Issue 4. Non‐invasive brain stimulation techniques aim to induce an electrical stimulation of the brain in an attempt to reduce chronic pain by directly altering brain activity. They include repetitive transcranial magnetic stimulation (rTMS), cranial electrotherapy stimulation (CES), transcranial direct current stimulation (tDCS), transcranial random noise stimulation (tRNS) and reduced impedance non‐invasive cortical electrostimulation (RINCE). Objectives To evaluate the efficacy of non‐invasive cortical stimulation techniques in the treatment of chronic pain. Search methods For this update we searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, LILACS and clinical trials registers from July 2013 to October 2017. Selection criteria Randomised and quasi‐randomised studies of rTMS, CES, tDCS, RINCE and tRNS if they employed a sham stimulation control group, recruited patients over the age of 18 years with pain of three months' duration or more, and measured pain as an outcome. Outcomes of interest were pain intensity measured using visual analogue scales or numerical rating scales, disability, quality of life and adverse events. Data collection and analysis Two review authors independently extracted and verified data. Where possible we entered data into meta‐analyses, excluding studies judged as high risk of bias. We used the GRADE system to assess the quality of evidence for core comparisons, and created three 'Summary of findings' tables. Main results We included an additional 38 trials (involving 1225 randomised participants) in this update, making a total of 94 trials in the review (involving 2983 randomised participants). This update included a total of 42 rTMS studies, 11 CES, 36 tDCS, two RINCE and two tRNS. One study evaluated both rTMS and tDCS. We judged only four studies as low risk of bias across all key criteria. Using the GRADE criteria we judged the quality of evidence for each outcome, and for all comparisons as low or very low; in large part this was due to issues of blinding and of precision. rTMS Meta‐analysis of rTMS studies versus sham for pain intensity at short‐term follow‐up (0 to < 1 week postintervention), (27 studies, involving 655 participants), demonstrated a small effect with heterogeneity (standardised mean difference (SMD) ‐0.22, 95% confidence interval (CI) ‐0.29 to ‐0.16, low‐quality evidence). This equates to a 7% (95% CI 5% to 9%) reduction in pain, or a 0.40 (95% CI 0.53 to 0.32) point reduction on a 0 to 10 pain intensity scale, which does not meet the minimum clinically important difference threshold of 15% or greater. Pre‐specified subgroup analyses did not find a difference between low‐frequency stimulation (low‐quality evidence) and rTMS appli...

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Characteristics Of Excluded Studies [Ordered By Study Id]mentioning

confidence: 99%

Non-invasive brain stimulation techniques for chronic pain

O’Connell

Marston

Spencer

et al. 2018

Cochrane Database of Systematic Reviews

105

View full text Add to dashboard Cite

show abstract

“…55 In a 2-week RCT, the effect of transcranial electric stimulation vs sham stimulation for PVD was investigated. 56 The intervention is a non-invasive method using direct current towards specific areas of the brain in an attempt to reduce pain during intercourse. None of the studies found any significant differences for variables related to pain, sexual satisfaction, anxiety or depression between the study groups (Table 6).…”

Section: Other Treatmentsmentioning

confidence: 99%

Treatment of Provoked Vulvodynia: A Systematic Review

Bohm‐Starke

Ramsay

Lytsy

et al. 2022

The Journal of Sexual Medicine

View full text Add to dashboard Cite

Background Treatment recommendations for provoked vulvodynia (PVD) are based on clinical experiences and there is a need for systematically summarizing the controlled trials in this field. Aim To provide an overview of randomized controlled trials and non-randomized studies of intervention for PVD, and to assess the certainty of the scientific evidence, in order to advance treatment guidelines. Data Sources The search was conducted in CINAHL (EBSCO), Cochrane Library, Embase (Embase.com), Ovid MEDLINE, PsycINFO (EBSCO) and Scopus. Databases were searched from January 1, 1990 to January 29, 2021. Study Eligibility Criteria Population: Premenopausal women with PVD. Interventions: Pharmacological, surgical, psychosocial and physiotherapy, either alone or as combined/team-based interventions. Control: No treatment, waiting-list, placebo or other defined treatment. Outcomes: Pain during intercourse, pain upon pressure or touch of the vaginal opening, sexual function/satisfaction, quality of life, psychological distress, adverse events and complications. Study design: Randomized controlled trials and non-randomized studies of interventions with a control group. Study Appraisal and Synthesis Methods 2 reviewers independently screened citations for eligibility and assessed relevant studies for risk of bias using established tools. The results from each intervention were summarized. Studies were synthesized using a narrative approach, as meta-analyses were not considered appropriate. For each outcome, we assessed the certainty of evidence using grading of recommendations assessment, development, and evaluation (GRADE). Results Most results of the evaluated studies in this systematic review were found to have very low certainty of evidence, which means that we are unable to draw any conclusions about effects of the interventions. Multimodal physiotherapy compared with lidocaine treatment was the only intervention with some evidential support (low certainty of evidence for significant treatment effects favoring physiotherapy). It was not possible to perform meta-analyses due to a heterogeneity in interventions and comparisons. In addition, there was a heterogeneity in outcome measures, which underlines the need to establish joint core outcome sets. Clinical Implications Our result underscores the need of stringent trials and defined core outcome sets for PVD. Strength and Limitations Standard procedures for systematic reviews and the Population Intervention Comparison Outcome model for clinical questions were used. The strict eligibility criteria resulted in limited number of studies which might have resulted in a loss of important information. Conclusion This systematic review underlines the need for more methodologically stringent trials on interventions for PVD, particularly for multimodal treatments approaches. For future research, there is a demand for joint core outcome sets.

show abstract

“…[7] Central neuromodulation, such as transcranial direct current stimulation (tDCS), alleviates pain by producing microcurrents that promote neuronal excitability and activate descending inhibition systems. [49] PTNS was performed by inserting a 34-gauge needle approximately 3 to 4 cm above the medial malleolus and 1 cm posterior to the tibia, along the running direction of the tibial nerve, placing the adhesive electrode on the medial heel, and then adjusting the stimulation amplitude, typically 30 min per session for consecutive 12 weeks. [47,50,51] A prospective study showed that PTNS could decrease pain and improve quality of life in women with CPP.…”

Section: Neuromodulationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Non-pharmacological therapies for treating chronic pelvic pain in women: A review

et al. 2022

View full text Add to dashboard Cite

Chronic pelvic pain (CPP) is an intricate condition with multiple etiologies that lead to indefinite pain mechanisms. Physicians and researchers are challenged in its treatment, and the combined therapy of pharmacologic and non-pharmacologic treatment has been recognized as a multidisciplinary approach cited by guidelines and adopted in clinical practice. As an alternative therapy for CPP, nonpharmacologic therapies benefit patients and deserve further study. This study reviews the literature published from January 1991 to April 2022 on non-pharmacologic therapies for CPP in adult women. Based on a survey, this review found that the most commonly used non-pharmacological therapies for CPP include pelvic floor physical therapy, psychotherapy, acupuncture, neuromodulation, and dietary therapy. By evaluating the efficacy and safety of each therapy, this study concluded that non-pharmacological therapies should be included in the initial treatment plan because of their high degree of safety and low rate of side effects. To fill the lack of data on non-pharmacologic therapies for CPP, this study provides evidence that may guide treatment and pain management.

show abstract

Efficacy of Transcranial Direct-Current Stimulation in Women With Provoked Vestibulodynia

Abstract: Short title: Brain stimulation in women with vestibulodynia. Condensation: Transcranial brain stimulation does not reduce pain intensity during intercourse in women with provoked vestibulodynia compared to sham stimulation.

Cited by 4 publications

References 45 publications

Non-invasive brain stimulation techniques for chronic pain

Non-invasive brain stimulation techniques for chronic pain

Treatment of Provoked Vulvodynia: A Systematic Review

Non-pharmacological therapies for treating chronic pelvic pain in women: A review

Contact Info

Product

Resources

About