Transcranial Direct Current Stimulation combined with Physiotherapy in the control of Chronic Pelvic Pain: a case report

Authors

  • Bárbara Cristina da Costa Vilar Gadelha Centro Universitário do Planalto Central Apparecido dos Santos (Brasília). Distrito Federal, Brazil. https://orcid.org/0000-0002-8158-7733
  • Bárbara Gabrielle Morais Maciel Centro Universitário do Planalto Central Apparecido dos Santos (Brasília). Distrito Federal, Brazil. https://orcid.org/0000-0002-0231-9758
  • Mariana Cecchi Salata Centro Universitário do Planalto Central Apparecido dos Santos (Brasília). Distrito Federal, Brazil. https://orcid.org/0000-0002-0955-9885
  • Milene Soares Nogueira de Lima Universidade de Brasília (Brasília). Distrito Federal, Brazil. https://orcid.org/0000-0001-5268-8343
  • Rafael Reis Olher Centro Universitário do Planalto Central Apparecido dos Santos (Brasília). Distrito Federal, Brazil. https://orcid.org/0000-0002-7363-9273
  • Thaís Gontijo Ribeiro Secretaria de Estado de Saúde do Distrito Federal (Brasília). Distrito Federal, Brazil. https://orcid.org/0000-0001-5246-9298

DOI:

https://doi.org/10.17267/2965-3738bis.2023.e5322

Keywords:

Pelvic Pain, Pelvic Floor Disorders, Physiotherapy, Transcranial Direct Current Stimulation, Neuromodulation

Abstract

INTRODUCTION: Chronic Pelvic Pain (CPP) is a non-menstrual pain condition of intense pain that can cause dysfunctions in some aspects such as quality of life, sexual function, among others. OBJECTIVES: To evaluate the effects of transcranial direct current stimulation (tDCS) on pain, as well as pelvic floor functionality, sexual dysfunction and quality of life in a patient with CPP. METHODS AND MATERIALS: This is a case report of patients with significant CPP who underwent tDCS for 5 consecutive days, targeting the dorsolateral prefrontal cortex (DLFPC) at 2mA for 20 minutes, in combination with physiotherapy. Pain scales, a sexual function questionnaire, pelvic floor muscle function and quality of life measures were used for evaluation. RESULTS: There was a 62.06% improvement in pain intensity and a 22.91% improvement in pain interference. The average pain score decreased from 10 at the start of the intervention (D0) to 3 in the first week (D1) and 6 in the second week (D2) of post-intervention menstruation. Regarding sexual function, the results were 31.2 at D0, 31.8 at D1 and 29.3 at D2. Improvement was observed in pelvic floor muscle strength, endurance, and repetitions at D1 and D2, although there was a decrease in strength compared to D2. The average scores for domains of quality of life were as follows: physical (55.95), psychological (59.72), social relationships (69.44) and environment (82.29). CONCLUSION: tDCS positively affected pain management and pelvic floor muscle function in the patient. However, there were no significant gains observed in other domains.

References

(1) Nogueira AA, Reis FJC, Poli Neto OB. Management of chronic pelvic pain in women. Rev Bras Ginecol Obstet. 2006;28(12):733-40. https://doi.org/10.1590/S0100-72032006001200008

(2) Godoi JE, Reis DRM, Carvalho JR, Deus JM. Chronic pelvic pain portraits: perceptions and beliefs of 80 women. BrJP. 2019;2(1):8-13. https://doi.org/10.5935/2595-0118.20190003

(3) American College of Obstetricians and Gynecologists (ACOG). Chronic Pelvic Pain: ACOG Practice Bulletin, Number 218. Obstet Gynecol. 2020;135(3):e98-e109. https://doi.org/10.1097/aog.0000000000003716

(4) Divandari N, Manshadi FD, Shokouhi N, Vakili M, Jaberzadeh S. Effect of one session of tDCS on the severity of pain in women with chronic pelvic pain. J Bodyw Mov Ther. 2019;23(3):678-82. https://doi.org/10.1016/j.jbmt.2017.12.014

(5) Fenton BW, Palmieri PA, Boggio P, Fanning J, Fregni F. A preliminary study of transcranial direct current stimulation for the treatment of refractory chronic pelvic pain. Brain Stimul. 2009;2(2):103-7. https://doi.org/10.1016/j.brs.2008.09.009

(6) Souza RVS, Maciel DG, Cerqueira MS. Effects of transcranial direct current stimulation associated or combined with exercise on musculoskeletal pain: systematic review. BrJP. 2021;4(2):167-71. https://doi.org/10.5935/2595-0118.20210029

(7) Vitor-Costa M, Pereira LA, Montenegro RA, Okano AH, Altimari LR. Transcranial direct current stimulation as an ergogenic aid: a new perspective in sport. Rev Educ Fis UEM. 2012;23(2):167-74. https://doi.org/10.4025/reveducfis.v23i2.10670

(8) Fernandes T, Dias ALA, Santos NA. Transcranial Direct Current Stimulation in Autism: Systematic Review. Psicol Teor Prat. 2017;19(1):192-207. http://dx.doi.org/10.5935/1980-6906/psicologia.v19n1p192-207

(9) Silva ACM, Schuffner LR, Pereira RGB. The effect of transcranial stimulation by continuing current in children with cerebral palsy. Revista Saúde dos Vales. 2020;1(2). https://doi.org/10.17648/2674-8584-v2-2020-22

(10) Pinto CB, Costa BT, Duarte D, Fregni F. Transcranial Direct Current Stimulation as a Therapeutic Tool for Chronic Pain. J ECT. 2018;34(3):e36-e50. https://doi.org/10.1097/yct.0000000000000518

(11) Harvey MP, Watier A, Rouleau ÉD, Léonard G. Non-invasive stimulation techniques to relieve abdominal/pelvic pain: Is more always better?. World J Gastroenterol. 2017;23(20):3758-60. https://doi.org/10.3748/wjg.v23.i20.3758

(12) Poquet N, Lin C. The Brief Pain Inventory (BPI). J Physiother. 2016;62(1):52. https://doi.org/10.1016/j.jphys.2015.07.001

(13) Martinez JE, Grassi DC, Marques LG. Análise da aplicabilidade de três instrumentos de avaliação de dor em distintas unidades de atendimento: ambulatório, enfermaria e urgência. Rev Bras Reumatol [Internet]. 2011;51(4):299-308. Available from: https://pesquisa.bvsalud.org/portal/resource/pt/lil-593316

(14) Driusso P, Beleza ACS. Avaliação fisioterapêutica da musculatura do assoalho pélvico feminino. Barueri: Editora Manole; 2018.

(15) Cielo A. Functionality of the pelvic floor of physically active elderly with and without urinary incontinence according to age stratum [dissertation] [Internet]. Santa Maria: Universidade Federal de Santa Maria; 2018. Available from: https://repositorio.ufsm.br/handle/1/14240

(16) Mazo GZ, Santos KM, Freitas CS, Cielo A, Braz MM, Pivetta HMF. Urinary incontinence and female sexual dysfunction in physically active older women. Fisioter Pesqui. 2021;28(1):109-16. https://doi.org/10.1590/1809-2950/21000528012021

(17) Hentschel H, Alberton DL, Capp E, Goldim JR, Passos EP. Validation of the Female Sexual Function Index (FSFI) for Portuguese language. Clin Biomed Res [Internet]. 2007;27(1):10-4. Available from: https://seer.ufrgs.br/index.php/hcpa/article/view/471

(18) Almeida-Brasil CC, Silveira MR, Silva KR, Lima MG, Faria CDCM, Cardoso CL, et al. Quality of life and associated characteristics: application of WHOQOL-BREF in the context of Primary Health Care. Ciênc Saúde Coletiva. 2017;22(5):1705-16. https://doi.org/10.1590/1413-81232017225.20362015

(19) Pires AMFS, Gusmão WDP, Carvalho LWT, Amaral MMLS. Quality of Life of Medical Students: Are There Changes during Undergraduate Training?. Rev Bras Educ Med. 2020;44(4):e124. https://doi.org/10.1590/1981-5271v44.4-20200008

(20) Utz KS, Dimova V, Oppenländer K, Kerkhoff G. Electrified minds: Transcranial direct current stimulation (tDCS) and Galvanic Vestibular Stimulation (GVS) as methods of non-invasive brain stimulation in neuropsychology—A review of current data and future implications. Neuropsychologia. 2010;48(10):2789-810. https://doi.org/10.1016/j.neuropsychologia.2010.06.002

(21) Frare JC, Tomadon A, Silva JR. Dysmenorrhea prevalence and its effect on quality of life among Young women. Rev Bras Ciênc Saúde. 2014;12(39):15-20. https://doi.org/10.13037/rbcs.vol12n39.2095

(22) Zakka TRM, Yeng LT, Teixeira MJ, Rosi Júnior J. Chronic non-visceral pelvic pain: multidisciplinary management. Case report. Rev Dor. 2013;14(3):231-3. https://doi.org/10.1590/S1806-00132013000300017

(23) Pegado R, Silva LK, Dantas HS, Câmara HA, Mescouto KA, Silva-Filho EM, et al. Effects of Transcranial Direct Current Stimulation for Treatment of Primary Dysmenorrhea: Preliminary Results of a Randomized Sham-Controlled Trial. Pain Med. 2020;21(12):3615-23. https://doi.org/10.1093/pm/pnz202

(24) Mechsner S, Grünert J, Wiese JJ, Vormbäumen J, Sehouli J, Siegmund B, et al. Transcranial direct current stimulation to reduce chronic pelvic pain in endometriosis: phase II randomized controlled clinical trial. Pain Med. 2023;24(7):809-17. https://doi.org/10.1093/pm/pnad031

(25) Matias MGL, Cavalcante AFL, Mescouto KA, Silva-Filho EM, Baptista AF, Okano AH, et al. Does anodal transcranial direct current stimulation over left motor cortex show body side pain-related difference in fibromyalgia?. BrJP. 2022;5(2):112-8. https://doi.org/10.5935/2595-0118.20220020

(26) Montenegro MLLS, Mateus-Vasconcelos ECL, Silva JCR, Nogueira AA, Reis FJC, Poli Neto OB. Importance of Pelvic Muscle Tenderness Evaluation in Women with Chronic Pelvic Pain. Pain Med. 2010;11(2):224-8. https://doi.org/10.1111/j.1526-4637.2009.00758.x

(27) Baracho E. Fisioterapia Aplicada à Saúde da Mulher. 6th. ed. Rio de Janeiro: Grupo GEN; 2018.

(28) Nogueira AA, Poli Neto OB, Silva JCR, Reis FJC. Myofascial syndrome: a common and underdiagnosed cause of chronic pelvic pain in women. Rev Bras Ginecol Obstet. 2009;31(9):425-6. https://doi.org/10.1590/S0100-72032009000900001

(29) Silva MPP, Marques AA, Amaral MTP. Tratado de fisioterapia em saúde da mulher. 2nd. ed. Rio de Janeiro: Grupo GEN; 2018.

(30) Hämmerli S, Kohl-Schwartz A, Imesch P, Rauchfuss M, Wölfler MM, Häberlin F, et al. Sexual Satisfaction and Frequency of Orgasm in Women With Chronic Pelvic Pain due to Endometriosis. J Sex Med. 2020;17(12):2417-26. https://doi.org/10.1016/j.jsxm.2020.09.001

(31) Lara LAS. Abordagem das disfunções sexuais femininas. In: Tópicos em saúde sexual. São Paulo: Febrasgo; 2017.

(32) Xavier IML, Loyola CMD, Oliveira RMP, Saidel MGB, Silva FMAM, Pachêco MAB. Chronic pelvic pain and its repercussions in women assisted in Primary Care. Res Soc Dev. 2021;10(5):e16410514693. https://doi.org/10.33448/rsd-v10i5.14693

(33) Berek JS. Berek & Novak: tratado de ginecologia. 15th. ed. Rio de Janeiro: Grupo GEN; 2014.

(34) Tripoli TM, Sato H, Sartori MG, Araujo FF, Girão MJBC, Schor E. Evaluation of Quality of Life and Sexual Satisfaction in Women Suffering from Chronic Pelvic Pain With or Without Endometriosis. J Sex Med. 2011;8(2):497-503. https://doi.org/10.1111/j.1743-6109.2010.01976.x

(35) Omidvar S, Bakouei F, Amiri FN, Begum K. Primary Dysmenorrhea and Menstrual Symptoms in Indian Female Students: Prevalence, Impact and Management. Glob J Health Sci. 2016;8(8):135-44. https://doi.org/10.5539%2Fgjhs.v8n8p135

(36) Durand H, Monahan K, McGuire BE. Prevalence and impact of dysmenorrhea among University students in Ireland. Pain Med. 2021;22(12):2835-45. https://doi.org/10.1093/pm/pnab122

(37) Karout S, Soubra L, Rahme D, Karout L, Khojah HMJ, Itani R. Prevalence, risk factors, and management practices of primary dysmenorrhea among young females. BMC Women’s Health. 2021;21(1):392. https://doi.org/10.1186/s12905-021-01532-w

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Published

10/05/2023

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Case reports

How to Cite

1.
Gadelha BC da CV, Maciel BGM, Salata MC, de Lima MSN, Olher RR, Ribeiro TG. Transcranial Direct Current Stimulation combined with Physiotherapy in the control of Chronic Pelvic Pain: a case report. Brain Imaging and Stimul. [Internet]. 2023 Oct. 5 [cited 2024 May 3];2:e5322. Available from: https://www5.bahiana.edu.br/index.php/brain/article/view/5322

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