Intervention par stimulation non-invasive du cerveau afin de réduire la douleur, les atteintes fonctionnelles, l'utilisation de médicaments contre la douleur, et le délai du retour au travail des patients ayant subi une blessure orthopédique concomitante à un traumatisme crâniocérébral léger

 

Louis De Beaumont

Centre de recherche de l'Hôpital du Sacré-Coeur de Montréal

 

Domaine : neurosciences, santé mentale et toxicomanies

Programme Consortium pour le développement de la recherche en traumatologie - Volet 1

Concours 2017-2018

Bone fracture is the most common type of orthopedic trauma (OT), accounting for 30 million cases in the United States each year. Pain management is a priority of care after OT due to its beneficial effects on healing, comfort, motor and cognitive recovery. Persistent pain or functional deficits are experienced in 30-50% of isolated limb fracture (ILF) cases, and lost work time accounts for most of its staggering financial burden. Concomitant mild traumatic brain injury (mTBI) (ILF+mTBI) nearly triples the time taken to return to work and self-reported pain symptoms are significantly higher at 3 months postinjury, thus making mTBI a highly prevalent and putative risk factor of poor prognosis after ILF. Inhibiting neuroinflammation (NI) is a promising clinical target to reduce pain symptoms after ILF.

There exists medications that are effective in reducing NI, but their significant side effects restrict long-term use. A multi-session non-invasive brain stimulation protocol called prolonged continuous theta-burst stimulation (pc-TBS) was shown to provide long-lasting analgesic effects. To date, no study has performed a longitudinal investigation of the analgesic effect of pc-TBS in ILF patients. Within 48 hours of injury (baseline), recruited ILF and ILF+mTBI patients will be studied on injury markers. Half of subjects from each group will undergo a 10-day pc-TBS protocol, while the other half will be assigned to a sham protocol. All subjects will be followed at 1, 3, and 12 months post-injury.

The application of pc-TBS to trauma patients could provide a much needed therapeutic alternative to reducing pain symptoms. In pc-TBS, adverse effects are minimal and functional gains are expected with the facilitation of brain plasticity mechanisms. By targeting all 4 major obstacles preventing trauma recovery, pc-TBS is likely to reduce the time taken to return and in so doing, its staggering financial burden.