Symptom Management in Adults With Knee Osteoarthritis Using Transcranial Direct Current Stimulation: A Pilot Study

2.50
Hdl Handle:
http://hdl.handle.net/10755/621490
Category:
Full-text
Format:
Text-based Document
Type:
Presentation
Level of Evidence:
N/A
Research Approach:
N/A
Title:
Symptom Management in Adults With Knee Osteoarthritis Using Transcranial Direct Current Stimulation: A Pilot Study
Other Titles:
Promoting Clinical Outcomes
Author(s):
Ahn, Hyochol; Fillingim, Roger
Lead Author STTI Affiliation:
Zeta Pi
Author Details:
Hyochol Ahn, PhD, MSN, MS-ECE, MS-CTS, RN, APRN, ANP-BC, Professional Experience: 2016 - Present -- Associate Professor and Endowed Trumble Professor in Aging Research, University of Texas Health Science Center at Houston School of Nursing, Houston, TX. 2012 - 2016 -- Assistant Professor, University of Florida College of Nursing, Gainesville, FL. 2011 - 2012 -- Advanced Registered Nurse Practitioner, Alliance Medical Practices, Inc., Ocala, FL. 2008 - 2011 -- Shands Hospital at the University of Florida, Gainesville, FL. Author or coauthor of 14 publications (9 as primary author) and 1 book chapter primarily relating to pain in older adults. Fifty presentations at scientific meetings (31 as primary author). Author Summary: With a unique background in electrical and computer engineering, Dr. Hyochol Ahn embarked on a nursing career to combine cutting-edge biomedical technology with nursing research to improve patient outcomes. His unique background and exceptional training in electrical and computer engineering, nursing science, genetics, clinical and translational science, and geriatrics as well as direct patient care experience as a nurse practitioner enhance his abilities as a nurse researcher in the care of older adults.
Abstract:

Purpose: Osteoarthritis is a leading cause of pain and functional impairments in people 45 years and older (Lakkireddy, Bedarakota, Vidyasagar, Rapur, & Karra, 2015). Noninvasive brain stimulation, such as Transcranial Direct Current Stimulation (tDCS), has received significant attention for the treatment of pain in chronic conditions owing to its neuromodulatory effect (Ayache et al., 2016; Woods et al., 2016). tDCS involves the application of weak direct electric current to the head in a noninvasive and painless manner, leading to the modulation of the brain activity involved in pain processing (DaSilva et al., 2016; O'Connell & Wand, 2015). Therefore, we assessed the preliminary efficacy and safety of tDCS on pain symptoms in adults with knee osteoarthritis.

Methods: We conducted a double-blind, randomized, sham-controlled pilot clinical study in 40 community-dwelling participants with knee OA who were 50−70 years old. The participants were randomly assigned to receive either five daily sessions of 2mA tDCS for 20 minutes or sham tDCS (1:1 for two groups). Randomization was performed by a statistician with no clinical involvement in this trial. The anode electrode was placed over the primary motor cortex of the hemisphere contralateral to the affected knee, and the cathode electrode was placed over the supraorbital region ipsilateral to the affected knee. Osteoarthritis-related pain symptoms were measured at baseline and after tDCS via the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The WOMAC consisted of 3 subscales relating to pain during activities (5 items), stiffness during the day (2 items), and impairments of physical function (17 items), with higher scores indicating worse pain, stiffness, and impairments of physical function. Also, we monitored possible side effects of tDCS by asking whether participants experienced the symptoms of tingling, itching sensation, burning sensation, pain, fatigue, nervousness, headache, difficulty concentrating, mood changes, or changes in vision or visual perception (Bikson et al., 2016). All the side effects were recorded, and their severity was graded from 0 (not at all) to 10 (highest degree). The safety questionnaire was administered after each stimulation session.

Results: The mean age was 59 years (Standard deviation = 8 years), and 53% were female. After five daily sessions, the tDCS group had a greater reduction than the sham group in pain during activities (active tDCS: 1.25 ± 3.13, sham: 0.60 ± 2.11), stiffness during the day (active tDCS: 0.55 ± 1.36, sham: 0.20 ± 0.83), and impairments of physical function (active tDCS: 2.40 ± 10.44, sham: 0.10 ± 7.33). Effect sizes (Cohen’s d) ranged from d=0.24 for reducing pain during activities (t=0.77, df=38, p=0.44), d=0.31 for reducing stiffness during the day (t=0.98, df=38, p=0.33), and d = 0.27 for reducing impairments of physical function (t=0.88, df=38, p=0.39). Also, all participants tolerated tDCS well without experiencing any significant adverse effects. No participants complained about fatigue, nervousness, headache, difficulty concentrating, mood changes, or vision changes during tDCS sessions. A few adverse events occurred during tDCS session, such as tingling, itching sensation, burning sensation, pain, and change in visual perception. However, these symptoms were mild (less than or equal to 2 out of 10) and transient, and the symptoms had resolved at the completion of the stimulation session.

Conclusion: Although our primary results were nonsignificant, there is a preliminary suggestion that tDCS targeting primary motor cortex may reduce osteoarthritis-related pain symptoms in adults with knee OA without any significant adverse effects. Future studies are needed to refine this novel approach for pain neuromodulation.

Keywords:
Osteoarthritis; Pain; Transcranial Direct Current Stimulation
Repository Posting Date:
14-Jun-2017
Date of Publication:
14-Jun-2017
Other Identifiers:
INRC17B14
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePresentationen
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleSymptom Management in Adults With Knee Osteoarthritis Using Transcranial Direct Current Stimulation: A Pilot Studyen_US
dc.title.alternativePromoting Clinical Outcomesen
dc.contributor.authorAhn, Hyocholen
dc.contributor.authorFillingim, Rogeren
dc.contributor.departmentZeta Pien
dc.author.detailsHyochol Ahn, PhD, MSN, MS-ECE, MS-CTS, RN, APRN, ANP-BC, Professional Experience: 2016 - Present -- Associate Professor and Endowed Trumble Professor in Aging Research, University of Texas Health Science Center at Houston School of Nursing, Houston, TX. 2012 - 2016 -- Assistant Professor, University of Florida College of Nursing, Gainesville, FL. 2011 - 2012 -- Advanced Registered Nurse Practitioner, Alliance Medical Practices, Inc., Ocala, FL. 2008 - 2011 -- Shands Hospital at the University of Florida, Gainesville, FL. Author or coauthor of 14 publications (9 as primary author) and 1 book chapter primarily relating to pain in older adults. Fifty presentations at scientific meetings (31 as primary author). Author Summary: With a unique background in electrical and computer engineering, Dr. Hyochol Ahn embarked on a nursing career to combine cutting-edge biomedical technology with nursing research to improve patient outcomes. His unique background and exceptional training in electrical and computer engineering, nursing science, genetics, clinical and translational science, and geriatrics as well as direct patient care experience as a nurse practitioner enhance his abilities as a nurse researcher in the care of older adults.en
dc.identifier.urihttp://hdl.handle.net/10755/621490-
dc.description.abstract<p><strong>Purpose: </strong><span>Osteoarthritis is a leading cause of pain and functional impairments in people 45 years and older (Lakkireddy, Bedarakota, Vidyasagar, Rapur, & Karra, 2015). Noninvasive brain stimulation, such as Transcranial Direct Current Stimulation (tDCS), has received significant attention for the treatment of pain in chronic conditions owing to its neuromodulatory effect (Ayache et al., 2016; Woods et al., 2016). tDCS involves the application of weak direct electric current to the head in a noninvasive and painless manner, leading to the modulation of the brain activity involved in pain processing (DaSilva et al., 2016; O'Connell & Wand, 2015). Therefore, we assessed the preliminary efficacy and safety of tDCS on pain symptoms in adults with knee osteoarthritis.</span></p> <p><strong>Methods: </strong>We conducted a double-blind, randomized, sham-controlled pilot clinical study in 40 community-dwelling participants with knee OA who were 50−70 years old. The participants were randomly assigned to receive either five daily sessions of 2mA tDCS for 20 minutes or sham tDCS (1:1 for two groups). Randomization was performed by a statistician with no clinical involvement in this trial. The anode electrode was placed over the primary motor cortex of the hemisphere contralateral to the affected knee, and the cathode electrode was placed over the supraorbital region ipsilateral to the affected knee. Osteoarthritis-related pain symptoms were measured at baseline and after tDCS via the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The WOMAC consisted of 3 subscales relating to pain during activities (5 items), stiffness during the day (2 items), and impairments of physical function (17 items), with higher scores indicating worse pain, stiffness, and impairments of physical function. Also, we monitored possible side effects of tDCS by asking whether participants experienced the symptoms of tingling, itching sensation, burning sensation, pain, fatigue, nervousness, headache, difficulty concentrating, mood changes, or changes in vision or visual perception (Bikson et al., 2016). All the side effects were recorded, and their severity was graded from 0 (not at all) to 10 (highest degree). The safety questionnaire was administered after each stimulation session.</p> <p><strong>Results: </strong>The mean age was 59 years (Standard deviation = 8 years), and 53% were female. After five daily sessions, the tDCS group had a greater reduction than the sham group in pain during activities (active tDCS: 1.25 ± 3.13, sham: 0.60 ± 2.11), stiffness during the day (active tDCS: 0.55 ± 1.36, sham: 0.20 ± 0.83), and impairments of physical function (active tDCS: 2.40 ± 10.44, sham: 0.10 ± 7.33). Effect sizes (Cohen’s d) ranged from d=0.24 for reducing pain during activities (t=0.77, df=38, p=0.44), d=0.31 for reducing stiffness during the day (t=0.98, df=38, p=0.33), and d = 0.27 for reducing impairments of physical function (t=0.88, df=38, p=0.39). Also, all participants tolerated tDCS well without experiencing any significant adverse effects. No participants complained about fatigue, nervousness, headache, difficulty concentrating, mood changes, or vision changes during tDCS sessions. A few adverse events occurred during tDCS session, such as tingling, itching sensation, burning sensation, pain, and change in visual perception. However, these symptoms were mild (less than or equal to 2 out of 10) and transient, and the symptoms had resolved at the completion of the stimulation session.</p> <p><strong>Conclusion: </strong>Although our primary results were nonsignificant, there is a preliminary suggestion that tDCS targeting primary motor cortex may reduce osteoarthritis-related pain symptoms in adults with knee OA without any significant adverse effects. Future studies are needed to refine this novel approach for pain neuromodulation.</p>en
dc.subjectOsteoarthritisen
dc.subjectPainen
dc.subjectTranscranial Direct Current Stimulationen
dc.date.available2017-06-14T17:35:59Z-
dc.date.issued2017-06-14-
dc.date.accessioned2017-06-14T17:35:59Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
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