TRANSCRANIAL DIRECT CURRENT STIMULATION IN CHRONIC PHASE OF CHIKUNGUNYA: PROTOCOL FOR A RANDOMIZED CLINICAL TRIAL
Transcranial Direct Current Stimulation, arbovirus infections, arthritis.
Introduction: Chikungunya virus infection is still an epidemic in Brazil with an incidence of 59.4 cases per 100,000 in the Northeast region. More than 60% of patients present with recurrent and remitting chronic arthralgia with debilitating pain that lasts for years. There are no specific therapeutic agents to treat and rehabilitate patients in the chronic phase of chikungunya. Persistent pain can lead to disability, requiring long-term pharmacological treatment. Non-drug therapies such as transcranial direct current stimulation (tDCS) emerge as a promising complementary approach for these patients. Objectives: We aimed to evaluate the improvement of pain and functionality in patients in the chronic phase of chikungunya using anodal tDCS over the primary motor cortex (C3/Fp2 assembly). Methods: the study describes a protocol of a parallel, double-blind, randomized controlled trial. Forty participants with chronic chikungunya will be randomized to an active or sham group. A total of 10 consecutive sessions lasting 20 min each will be administered over 2 weeks, using a single-phase direct current with an intensity of 2 mA for 20 min. Participants in both groups will be assessed at baseline, immediately after the 10th session, 2 weeks (first follow-up) and 4 weeks (second follow-up) after the intervention. As a primary outcome, we will assess pain using a numerical rating scale and algometry. As secondary outcomes we will assess functionality, muscle strength and quality of life. The effects of stimulation will be calculated using a mixed analysis of variance (ANOVA) model. Expected results: The application of tDCS in the described assembly is already recommended for chronic pain syndromes and rheumatic diseases. It is expected that the outcomes will improve only in the active group, contributing to the strengthening of this resource for this population. In this way, we will have one more therapeutic tool option available and additional data for the scientific discussion around clinical policies and future trials.