Motor cortex transcranial direct current stimulation effects on knee osteoarthritis pain in elderly subjects with dysfunctional descending pain inhibitory system: A randomized controlled trial

Tavares, Daniela Regina Brandão; Okazaki, Jane Érika Frazão; Santana, Márcia Valéria de Andrade; Pinto, Ana Carolina Pereira Nunes; Tutiya, Karina Kuraoka; Gazoni, Fernanda Martins; Pinto, Camila Bonin; Santos, Fânia Cristina; Fregni, Felipe; Trevisani, Virgínia Fernandes Moça

doi:10.1016/j.brs.2021.02.018

Cited by 25 publications

(55 citation statements)

References 65 publications

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“…In our study, physical functioning, as measured with the BPI, showed an improvement of 12.9 points at T2. These results differ from those obtained by Tavares et al ( 78 )—the only other study to evaluate physical functioning with the BPI—who reported a decrease of only 2.27 points after 15 sessions of tDCS. The observations of Tavares et al are consistent with those of Ahn et al ( 74 )—who used the Western Ontario and McMaster Universities Index (WOMAC) to evaluate the impact of pain on physical functioning and who failed to observe significant improvement following five sessions of tDCS—but contrasts with the results of four other studies, all of which observed significant improvements in WOMAC scores following tDCS treatments ( 28 , 29 , 76 , 77 ).…”

Section: Discussioncontrasting

confidence: 99%

“…Importantly, the percentages of hypoalgesia measured at T2 and T3 were found to be clinically significant, suggesting that patients with chronic pain may actually benefit from pain reduction achieved with tDCS ( 51 , 70 ). Our observations are consistent with the results of previous work looking into the efficacy of tDCS in older adults suffering from chronic pain, all of which obtained positive results ( 29 , 30 , 74 – 78 ). Although all these studies point in the same direction, the magnitude of pain reduction and the long-lasting effect vary from one study to another.…”

Section: Discussionsupporting

confidence: 93%

“…Tingling was the most common effect observed in our participants, followed by, but far ahead of, headache and sensations of heat under the electrodes, which were both reported twice. Tingling was also reported by Concerto et al ( 30 ), Ahn et al ( 74 ), and Tavares et al ( 78 ). Interestingly, Tavares et al noted that tingling sensation and headache were significantly higher among their sham tDCS group ( 78 ).…”

Section: Discussionsupporting

confidence: 68%

“…Tingling was also reported by Concerto et al ( 30 ), Ahn et al ( 74 ), and Tavares et al ( 78 ). Interestingly, Tavares et al noted that tingling sensation and headache were significantly higher among their sham tDCS group ( 78 ).…”

Section: Discussionsupporting

confidence: 68%

“…This follow-up period, although relatively short, is one of the strengths of this study, as most of the other studies looking into the effect of tDCS in older adults did not plan any follow-up assessments ( 28 , 29 , 75 – 77 ). From the only 3 studies which included a follow-up period, 1 reported no lasting effect of tDCS ( 78 ) and 2 reported a sustained reduction of pain intensity ( 30 , 74 ). One of these studies also observed an improvement in physical functioning and anxiety symptoms during a 1-week follow-up ( 30 ).…”

Section: Discussionmentioning

confidence: 99%

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Relieving Chronic Musculoskeletal Pain in Older Adults Using Transcranial Direct Current Stimulation: Effects on Pain Intensity, Quality, and Pain-Related Outcomes

et al. 2022

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IntroductionChronic pain is a significant health problem and is particularly prevalent amongst the elderly. Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that has been proposed to reduce chronic pain. The aim of this study was to evaluate and compare the efficacy of active and sham tDCS in reducing pain in older individuals living with chronic musculoskeletal pain.Materials and MethodsTwenty-four older individuals (mean age: 68 ± 7 years) suffering from chronic musculoskeletal pain were randomized to receive either anodal tDCS over the contralateral motor cortex (2 mA, 20 min; n = 12) or sham tDCS (20 min; n = 12) for five consecutive days. Pain logbooks were used to measure pain intensity. Questionnaires (McGill Pain Questionnaire, Brief Pain Inventory, Beck Depression Inventory [BDI], Beck Anxiety Inventory, Pain Catastrophizing Scale [PCS], and Margolis Pain Drawing and Scoring System [MPDSS]) were also used to assess pain in its globality.ResultsAnalysis of pain logbooks revealed that active tDCS led to a reduction in daily average pain intensity (all p ≤ 0.04), while sham tDCS did not produce any change (p = 0.15). Between-group comparisons for change in pain intensity reduction between active and sham tDCS showed a trend during treatment (p = 0.08) which was significant at the follow-up period (p = 0.02). Active tDCS also improved scores of all questionnaires (all p ≤ 0.02), while sham tDCS only reduced MPDSS scores (p = 0.04). Between-group comparisons for the pain-related outcomes showed significant differences for BDI et PCS after the last tDCS session.ConclusionsThese results suggest that anodal tDCS applied over the primary motor cortex is an effective modality to decrease pain in older individuals. tDCS can also improve other key outcomes, such as physical and emotional functioning, and catastrophic thinking.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 68%

Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

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Relieving Chronic Musculoskeletal Pain in Older Adults Using Transcranial Direct Current Stimulation: Effects on Pain Intensity, Quality, and Pain-Related Outcomes

et al. 2022

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

Yang,

Li,

Wang

et al. 2024

Arthritis Care & Research

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BackgroundThe effects of transcranial direct current stimulation (tDCS) in the treatment of knee osteoarthritis (KOA) is still unclear.ObjectiveTo evaluate the efficacy and safety of tDCS in improving symptoms in patients with KOA.Data sources and study selectionThe following electronic databases were searched for eligible randomized controlled trials (RCTs): PubMed, EMBASE, Web of Science, and the Cochrane Library. The search was performed from the inception dates to April 30, 2023.Data extraction and synthesisData extraction and quality assessment were performed by 2 independent reviewers. Standard mean differences (SMDs) with 95% confidence intervals (95% CIs) for pooled data were calculated. A random‐effects model was used for the data analyses.Main outcomes and measuresThe primary outcomes were pain and physical function. Secondary outcomes included stiffness, mobility performance, quality of life, pressure pain tolerance, and plasma levels of brain‐derived neurotrophic factor (BDNF).ResultsThis meta‐analysis included 13 RCTs. tDCS was significantly associated with pain decrease compared with sham tDCS (SMD = ‐0.62, 95% CI: [‐0.87, ‐0.37], P < 0.00001). When compared tDCS plus other non‐tDCS with sham tDCS plus other non‐tDCS, there was no longer an significant association with pain decrease (SMD = ‐0.45, 95% CI: [‐1.08, 0.17], P = 0.16). The changes in physical function were not significantly different between the tDCS and sham tDCS groups. (SMD = ‐0.09, 95% CI: [‐0.56, 0.38], P = 0.71). When compared tDCS plus other non‐tDCS with sham tDCS plus other non‐tDCS, there was still no significant association with improvement in physical function (SMD = ‐0.66, 95% CI: [‐1.63, 0.30], P = 0.18). There was no significant difference with improvement in stiffness (SMD = ‐0.21, 95% CI: [‐0.77, 0.34], P = 0.45), mobility performance (SMD = 4.58, 95% CI: [‐9.21, 18.37], P = 0.51), quality of life (SMD = ‐7.01, 95% CI: [‐22.61, 8.59], P = 0.38), pressure pain tolerance (SMD = 0.30, 95% CI: [‐0.09, 0.69], P = 0.13). There was a statistically significant reduction in plasma levels of BDNF (SMD = ‐13.57, 95% CI: [‐24.23, ‐2.92], P = 0.01)ConclusionsIn conclusion, tDCS could significantly alleviate pain, but it might had no efficacy in physical function, stiffness, mobility performance, quality of life, pressure pain tolerance among KOA patients.

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Cross‐sectional and longitudinal analysis of conditioned pain modulation and pain in fibromyalgia: CPM as an effect modifier of pain changes over time

Castelo‐Branco,

Pacheco‐Barrios,

Cardenas‐Rojas

et al. 2024

Physiotherapy Res Intl

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Background and PurposeFibromyalgia (FM) is associated with altered descending pain modulatory pathways, which can be assessed through Conditioned Pain Modulation (CPM). In this study, we aimed to explore the relationship between CPM and self‐reported baseline characteristics in patients with fibromyalgia. We also performed a longitudinal analysis exploring CPM as a potential predictor of clinical improvement over time in individuals with FM.MethodsWe performed cross‐sectional univariable and multivariable analyses of the relationship between CPM and other variables in 41 FM patients. We then performed longitudinal analyses, building linear mixed‐effects models with pain in the Visual Analogue Scale (VAS) as the dependent variable, and testing for the interaction between time and CPM. We also tested the interaction between CPM and time in models using other outcomes, such as the revised Fibromyalgia Impact Questionnaire and Quality of Life Scale (QOLs).ResultsWe found no association between CPM and other demographic and clinical variables in the univariable analysis. We found a statistically significant association in the multivariable linear regression model between CPM and the QOLs at the baseline after controlling for age, sex, and duration of symptoms. In the longitudinal analyses, we found that CPM is an effect modifier for clinical improvement over time for the pain VAS, QOLs, and FIQR: individuals with low‐efficient CPM at the baseline have a different (improved) pattern of response over time when compared to those with high‐efficient CPM.ConclusionsOur findings suggest that CPM is not a reliable biomarker of clinical manifestations in chronic pain patients during cross‐sectional assessments. However, our results are consistent with previous findings that CPM can be used to predict the evolution of clinical pain over time. We expect that our findings will help in the selection of patients with the best profile to respond to specific interventions and assist clinicians in tailoring pain treatments.

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Motor cortex transcranial direct current stimulation effects on knee osteoarthritis pain in elderly subjects with dysfunctional descending pain inhibitory system: A randomized controlled trial

Cited by 25 publications

References 65 publications

Relieving Chronic Musculoskeletal Pain in Older Adults Using Transcranial Direct Current Stimulation: Effects on Pain Intensity, Quality, and Pain-Related Outcomes

Relieving Chronic Musculoskeletal Pain in Older Adults Using Transcranial Direct Current Stimulation: Effects on Pain Intensity, Quality, and Pain-Related Outcomes

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

Cross‐sectional and longitudinal analysis of conditioned pain modulation and pain in fibromyalgia: CPM as an effect modifier of pain changes over time

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