Transcranial direct current stimulation (tDCS), performed at home but monitored remotely, is feasible and effective in management osteoarthritis (OA) pain in older adults, shows new research.
In a small open-label study of 20 patients with knee OA, 2 weeks of home treatment with tDCS significantly reduced pain scores by more than 50%. In addition, treatment was well tolerated.
Dr. Hyochol Brian Ahn
“Osteoarthritis is the most common cause of pain in older adults and the knee is the most affected joint,” said study study Hyochol Brian Ahn, PhD in the Isla Carroll Turner Chair in Gerontological Nursing, Science Center the University of Texas Health, Houston, Texas, said Medscape Medical News.
“Osteoarthritis pain management is particularly difficult in older adults because the pain only partially responds to existing pharmacological approaches, in addition, these medications can often present significant adverse events,” he added.
The results were presented at the 2021 annual meeting of the American American Academy of Pain Medicine (AAPM) virtual.
The brain as a regulator of pain
There is a growing interest in the role the brain plays in regulating pain, Ahn said. Previous research suggests that tDCS produces analgesic effects.
“We determine the severity of knee osteoarthritis by X-rays, but often the severity of osteoarthritis does not correlate with the patient’s perception of pain. We see completely worn joints, and yet patients do not complain of pain. or disability.
“Thinking about this disconnect has led to a consensus that the brain, which is an electrochemical organ, has a role to play in pain management,” he added.
Ahn recently began using tDCS to treat his elderly patients with knee OA. He observed an improvement in pain scores. The only problem, he said, is that patients have to go to the clinic every week for two weeks, which can be heavy for some patients.
To evaluate the feasibility and efficacy of providing self-administered and remotely monitored tDCS, Ahn studied 20 patients (15 women, five men) with knee OA for an average of 30 months. Patients ranged in age from 50 to 85 years.
The tDCS intervention consisted of a constant current of 2 mA applied for 20 minutes once a day from Monday to Friday for 2 weeks for a total of 10 sessions. Patients received the tDCS team and were remotely monitored by research staff trained in each treatment session.
Pain intensity was measured using the visual analog scale (VAS). On this scale, scores range from 0 mm, which indicates no pain, to 100 mm, indicating the worst pain imaginable. After 2 weeks of home-based treatment, the mean VAS score was significantly reduced from baseline, from 55.23 at the beginning of treatment to 24.85 at the end of treatment (Pg <.01).
Based on the positive findings of this pilot study, Ahn has received a three-year fellowship from the National Institutes of Health (NIH) to continue his research.
“Right now, we are recruiting 120 patients and randomly receiving them to receive the intervention or a simulated intervention to elevate our results on the analgesic effect of a home-based application of transcranial direct current stimulation in older adults.” , he said.
Even the first days
Commenting on the research of Medscape Medical News, W. Michael Hooten, MD, professor of anesthesiology at the Mayo Clinic, Rochester, Minnesota, said that while these early findings are positive, “the long-term pain outcomes and potential effects of TDCS on physical and emotional functioning await the results of the NIH-funded RCT [randomized control trial]. “
Dr. Ajay J. Wasan
Also commenting on the findings, Ajay J. Wasan, MD, professor of anesthesiology, perioperative medicine and psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, said the researchers “seem to have conquered the question of how to administer the ‘transcranial stimulation at home’.
He added that while the results are encouraging, the modality and method of delivery “should definitely be tested in a randomized controlled trial to determine if this is an effective treatment.”
The study was funded by Theodore J. and Mary E. Trumble Endowment of the University of Texas Health Sciences Center in Houston. Ahn, Wooten and Wasan do not report relevant financial relationships.
2021 Annual Meeting of the American Academy of Pain Medicine (AAPM).
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