Efficacy of combining home-based transcranial direct current stimulation with mindfulness-based meditation for pain in older adults with knee osteoarthritis: A randomized controlled pilot study

Ahn, Hyochol; Zhong, Chengxue; Miao, Hongyu; Chaoul, Alejandro; Park, Lindsey; Yen, Irene H.; Vila, Manuel A.; Sorkpor, Setor K.; Abdi, Salahadin

doi:10.1016/j.jocn.2019.08.047

Cited by 52 publications

(77 citation statements)

References 39 publications

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“…This is in line with previous studies. For example, Ahn et al [ 38 ] showed that 10 sessions of tDCS targeting C3 or C4 combined with mindfulness-based meditation in older adults with knee osteoarthritis significantly improved clinical pain and experimental pain sensitivity. Labbe et al [ 39 ] demonstrated that tDCS targeting the right S1 improved vibrotactile detection and the discrimination threshold of the middle finger in healthy younger adults compared to sham.…”

Section: Discussionmentioning

confidence: 99%

Effects of Combining High-Definition Transcranial Direct Current Stimulation with Short-Foot Exercise on Chronic Ankle Instability: A Pilot Randomized and Double-Blinded Study

Yin

Zhuang

et al. 2020

Brain Sciences

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(1) Background: Balance decline is highly prevalent in people suffering from chronic ankle instability (CAI). The control of balance depends upon multiple neurophysiologic systems including the activation of cortical brain regions (e.g., the primary sensorimotor cortex). The excitability of this region, however, is diminished in people with CAI. In this pilot double-blinded randomized controlled trial, we tested the effects of high-definition transcranial direct current stimulation (HD-tDCS) designed to facilitate the excitability of M1 and S1 in combination with short-foot exercise (SFE) training on proprioception and dynamic balance performance in individuals with CAI. (2) Methods: Thirty young adults completed baseline assessments including the Active Movement Extent Discrimination Apparatus (AMEDA), Joint Position Reproduction (JPR) test, Y-balance test, and the Sensory Organization Test (SOT). They were then randomized to receive a four-week intervention of SFE in combination with tDCS (i.e., HD-tDCS+SFE) or sham (i.e., control) stimulation. Baseline assessments were repeated once-weekly throughout the intervention and during a two-week follow-up period. (3) Results: Twenty-eight participants completed this study. Blinding procedures were successful and no adverse events were reported. As compared to the control group, the HD-tDCS+SFE group exhibited significant improvements in the JPR test, the Y balance test, and the SOT at different time points. No group by time interaction was observed in AMEDA test performance. (4) Conclusions: HD-tDCS combined with SFE may improve dynamic balance and proprioception in CAI. Larger, more definitive trials with extended follow-up are warranted.

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Section: Discussionmentioning

confidence: 99%

Effects of Combining High-Definition Transcranial Direct Current Stimulation with Short-Foot Exercise on Chronic Ankle Instability: A Pilot Randomized and Double-Blinded Study

Yin

Zhuang

et al. 2020

Brain Sciences

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“…Notably, our group is currently investigating the efficacy of tDCS as a therapeutic, nonpharmacological approach to chronic knee pain in a series of randomized clinical trials, and pilots studies conducted thus far have shown a significant reduction of pain perception associated with neuromodulation. 30,31,[31][32][33][34] A large-scale demonstration of the effects of tDCS on clinical pain through a clinical trial has yet to be completed, hence the goals of this pilot study of relating fNIRS-derived cortical hemodynamics to longitudinal tDCS and to self-reported pain measures (regardless whether the pain is altered by tDCS alone or in addition to other factors) can be considered independent from each other. Also of relevance, prior research had used fNIRS to measure the cortical hemodynamic response to thermal pain, 39,46,47,55 but our pilot study appears to be the first where fNIRS data in response to thermal stimulation has been acquired concurrently with a tDCS treatment longitudinally for two weeks (three longitudinal sessions: one observation before treatment and two observations during the treatment).…”

Section: Discussionmentioning

confidence: 99%

“…23 This M1-SO electrode montage purportedly increases the excitability of afferent or efferent neuronal structures involved in pain processing and increases pain inhibitory controls on the motor, somatosensory, and frontal cortices implicated in pain sensitivity. [24][25][26][27][28][29] Our group [30][31][32][33][34] as well as others 24,25,[27][28][29]35 have shown that a 2-mA current, M1-SO tDCS treatment applied in the clinic effectively improves chronic pain function in a variety of populations, including knee OA. In addition, of relevance to this study, the portability, connectivity, and relative ease-of-use of modern tDCS devices make this neuromodulation technique suitable for an in-home, selfadministered regimen that avoids patients' daily visits to a clinical site.…”

Section: Introductionmentioning

confidence: 95%

“…Notably, the relationship between tDCS treatment and clinical measures of pain is undemonstrated, although our group has recently significantly contributed to this quest. [30][31][32][33][34] Briefly, fNIRS is an optical technique that measures cerebral hemodynamic activity at the cortical level by illuminating the cortical layer with nonionizing near-infrared light (i.e., with wavelengths between 650 and 1000 nm) and by detecting the light back scattered by such tissues. fNIRS uses light at multiple wavelengths (typically two) to measure concentration changes of oxygenated hemoglobin (HbO) and deoxygenated hemoglobin (HbR), thus providing functionally relevant insight into cortical hemodynamics and oxidative metabolism.…”

Section: Introductionmentioning

confidence: 99%

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Longitudinal effect of transcranial direct current stimulation on knee osteoarthritis patients measured by functional infrared spectroscopy: a pilot study

2020

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Significance: Knee osteoarthritis (OA) is a common joint disease causing chronic pain and functional alterations (stiffness and swelling) in the elderly population. OA is currently treated pharmacologically with analgesics, although neuromodulation via transcranial direct current stimulation (tDCS) has recently generated a growing interest as a safe side-effect free treatment alternative or a complement to medications for chronic pain conditions. Although a number of studies have shown that tDCS has a beneficial effect on behavioral measures of pain, the mechanistic action of neuromodulation on pain sensitivity and coping at the central nervous system is not well understood. Aim: We aimed at observing longitudinal changes of cortical hemodynamics in older adults with knee OA associated with a two-week-long tDCS self-treatment protocol. Approach: Hemodynamics was measured bilaterally in the motor and somatosensory cortices with functional near-infrared spectroscopy (fNIRS) in response to thermal pain induced ipsilaterally to the knee primarily affected by OA. Results: We found that both oxyhemoglobin-and deoxyhemoglobin-related functional activations significantly increased during the course of the tDCS treatment, supporting the notion that tDCS yields an increased cortical excitability. Concurrently, clinical measures of pain decreased with tDCS treatment, hinting at a potential spatial dissociation between cortically mediated pain perception and suppression and the prevalence of neuromodulatory effects over cortical pain processing. Conclusions: fNIRS is a valid method for objectively tracking pain in an ambulatory setting and it could potentially be used to inform strategies for optimized tDCS treatment and to develop innovative tDCS protocols.

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“…Detailed selection criteria and enrollment procedures were described in our previous work. 26 Briefly, 30 participants between ages 50 and 85 with self-reported knee OA pain level of at least 30 on the Numerical Rating Scale (0: no pain; 100: most intense pain imaginable) in the past 3 months were recruited in Southeast Texas. According to the American College of Rheumatology criteria, 27 participants met at least three of six criteria for symptomatic knee OA, namely age more than 50 years, stiffness less than 30 minutes, crepitus, bony tenderness, bony enlargement, and no palpable warmth.…”

Section: Methods Participantsmentioning

confidence: 99%

Functional Near‐Infrared Spectroscopy to Assess Central Pain Responses in a Nonpharmacologic Treatment Trial of Osteoarthritis

Pollonini

Montero‐Hernández

Park

et al. 2020

Journal of Neuroimaging

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BACKGROUND AND PURPOSE: Knee osteoarthritis (OA) is a common source of pain in older adults. Although OA-induced pain can be relieved with analgesics and anti-inflammatory drugs, the current opioid epidemic is fostering the exploration of nonpharmacologic strategies for pain mitigation. Amongs these, transcranial direct current stimulation (tDCS) and mindfulnessbased meditation (MBM) hold potential for pain-relief efficacy due to their neuromodulatory effects of the central nervous system, which is known to play a fundamental role in pain perception and processing. METHODS: In this double-blind study, we used functional near-infrared spectroscopy (fNIRS) to investigate the effects of tDCS combined with MBM on underlying pain processing mechanisms at the central nervous level in older adults with knee OA. Nineteen subjects were randomly assigned to two groups undergoing a 10-day active tDCS and MBM regimen and a sham tDCS and MBM regimen, respectively. RESULTS: Our results showed that the neuromodulatory intervention significantly relieved pain only in the group receiving active treatment. We also found that only the active treatment group showed a significant increase in oxyhemoglobin activation of the superior motor and somatosensory cortices colocated to the placement of the tDCS anodal electrode. To our knowledge, this is the first study in which the combined effect of tDCS and MBM is investigated using fNIRS. CONCLUSION: In conclusion, fNIRS can be effectively used to investigate neural mechanisms of pain at the cortical level in association with nonpharmacological, self-administered treatments.

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Efficacy of combining home-based transcranial direct current stimulation with mindfulness-based meditation for pain in older adults with knee osteoarthritis: A randomized controlled pilot study

Cited by 52 publications

References 39 publications

Effects of Combining High-Definition Transcranial Direct Current Stimulation with Short-Foot Exercise on Chronic Ankle Instability: A Pilot Randomized and Double-Blinded Study

Effects of Combining High-Definition Transcranial Direct Current Stimulation with Short-Foot Exercise on Chronic Ankle Instability: A Pilot Randomized and Double-Blinded Study

Longitudinal effect of transcranial direct current stimulation on knee osteoarthritis patients measured by functional infrared spectroscopy: a pilot study

Functional Near‐Infrared Spectroscopy to Assess Central Pain Responses in a Nonpharmacologic Treatment Trial of Osteoarthritis

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