Changes in Experimental Pain Sensitivity from Using Home-Based Remotely Supervised Transcranial Direct Current Stimulation in Older Adults with Knee Osteoarthritis

Abstract

Objective The present study examined the effects of home-based remotely supervised transcranial direct current stimulation on quantitative sensory testing measurements in older adults with knee osteoarthritis. Participants were hypothesized to experience improved pain measurements over time. Design Open-label, single-arm trial. Setting Southeast Texas between March and November 2018 at a nursing school and participant homes. Subjects Older adults (aged 50–85 years) with self-reported unilateral or bilateral knee osteoarthritis pain who met eligibility criteria set by the American College of Rheumatology. Methods The intervention was applied with a constant current intensity for 20 minutes every weekday for two weeks (10 total sessions). Quantitative measures of pain were collected three times over 10 days (days 1, 5, and 10) and included heat threshold and tolerance, pressure pain threshold, punctate mechanical pain, pain, and conditioned pain modulation. Analyses used nonparametric tests to evaluate differences between day 1 and day 10. Generalized linear mixed models were then used to evaluate change across all three time points for each measure. Bayesian inference was used to provide the posterior probability of longitudinal effects. Results Nonparametric tests found improvements in seven measures, and longitudinal models supported improvements in 10 measures, with some nonlinear effects. Conclusions The home-based, remotely supervised intervention improved quantitative measurements of pain in older adults with knee osteoarthritis. This study contributes to the growing body of literature supporting home-based noninvasive stimulation interventions.

Changes in Brain-derived Neurotrophic Factor From Active and Sham Transcranial Direct Current Stimulation in Older Adults With Knee Osteoarthritis

“…7,8 The present authors investigated the relative effects of sham versus active tDCS on measures of clinical pain, qualitative sensory testing measures, and peripheral inflammatory markers. [9][10][11] The neurobiological mechanisms of action for tDCS are an active subject of investigation in the literature, and heterogeneity in anode/cathode placement complicates the issue. A recent review 12 summarized the current understanding of these mechanisms: in brief, multisession tDCS is thought to regulate cortical information processing efficiency and induce continuous enhancement of signal transduction between neurons (ie, long-term potentiation).…”

“…This technique involves applying 2 electrodes of direct current over the scalp: (1) the anode, increasing local cortical excitability, and (2) the cathode, which decreases excitability 7,8. The present authors investigated the relative effects of sham versus active tDCS on measures of clinical pain, qualitative sensory testing measures, and peripheral inflammatory markers 9–11…”

Transcranial Direct Current Stimulation for Knee Osteoarthritis: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

“…In total, 13 RCTs were included, with sample sizes ranging from 15 to 60, but that does not mean that there is quantitive evidence from 13 trials for every outcome measure (pain, physical function, stiffness, mobility performance, quality of life, pressure pain tolerance, and plasma levels of BDNF). The individuals included within studies by Ahn et al, 19,27 Suchting et al, 17,32 Geraldine (1) et al, 34 and Geraldine (2) et al 35 were repeated. However, different outcomes and measuring method of outcomes were reported in these studies.…”

“…11 Recent evidence improved our knowledge about the central sensitization mechanism of KOA pain, [12][13][14] and nonpharmacologic interventions targeting central nervous system (CNS) pain processing have shown an effect on pain relief. 15,16 Transcranial direct current stimulation (tDCS) 17 is a noninvasive and relatively painless brain stimulation technique that can modify cortical excitability via applying low-amplitude direct electrical current over the scalp and is easy to administer. The effects of tDCS on pain relief might be associated with the modulation of the balance in the endogenous pain pathways while reversing maladaptive neuroplasticity.…”

Efficacy of Home-Based Transcranial Direct Current Stimulation on Experimental Pain Sensitivity in Older Adults with Knee Osteoarthritis: A Randomized, Sham-Controlled Clinical Trial

“…We then decided to determine if similar benefits could be obtained using home-based tDCS without the controlled environment of a clinic. Our open-label pilot study showed the preliminary benefits of home-based tDCS on experimental pain sensitivity [ 14 ] along with our randomized controlled pilot trial combining home-based tDCS with a mindfulness-based approach [ 15 ]. Building on these initial findings, examining the efficacy of home-based tDCS on clinical pain intensity, experimental pain sensitivity, and their relationship in a large-scale controlled trial may strengthen our understanding in uncovering the underlying mechanism of action.…”