Efeito da estimulação transcraniana por corrente contínua na artralgia crônica pós-Chikungunya

Abstract

Background: Chikungunya Virus (CHIKV) is an alphavirus belonging to the Togaviridae family, causing Chikungunya Fever, which typically presents with high fever, muscle pain, bilateral joint pain, headache, and joint swelling. In the first quarter of 2023, Brazil reported 174,517 possible cases of CHIKV. Although the rate of severe adverse events from CHIKV is low, a significant proportion of individuals develop the chronic phase. It is estimated that over 52% of the CHIKV-infected population will suffer from CHIKV chronic polyarthralgia and joint edema for more than six years. Given this scenario, there is a need for clinical research on non-pharmacological therapies for pain management in this population. Transcranial Direct Current Stimulation (tDCS) has emerged as a potential clinical approach for managing chronic pain in this population. Objective: To evaluate the effects of tDCS on pain, functional capacity, catastrophizing, kinesiophobia, quality of life, and sleep quality in individuals with chronic Chikungunya Fever. Methods: A randomized, controlled, double-blind, two-arm clinical trial was conducted. Thirty volunteers were divided into two groups (active-tDCS and sham-tDCS). tDCS was applied with the C3/Fp2 montage for 20 minutes at an intensity of 2mA for 10 consecutive days. The Visual Analog Scale (VAS) was used to evaluate the primary outcome in all of the assessments that have been done, while the SF-36 questionnaire, Hamilton Anxiety Scale, Catastrophic Scale, Tampa Scale of Kinesiophobia, Health Assessment Questionnaire (HAQ), Pittsburgh Sleep Quality Index, Weight-Bearing Lung Test, hand and lumbar dynamometry, time up and go (TUG) test, elbow flexion, and stationary march were used for secondary outcomes. Results: Thirty volunteers were composed this research. ANOVA showed a significant interaction between group and time for pain (p=0.03) with a significant time interaction (p=0.0001) between the groups. The 2-minute step test did not show a significant interaction between time and group (p=0.18), but the groups differed significantly on day 10 (p=0.01), first follow-up (p=0.01), and second follow-up (p=0.03). There was a clinical improvement in SF-36, but no statistically significant differences could be demonstrated. There was no statistically significant improvement in mental health and physical tests. Conclusion: tDCS may be a promising intervention for reducing pain in patients with chronic arthralgia due to CHIKV, although further research is needed to confirm these findings and explore potential long-term benefits.