Transcranial Direct Current Stimulation with Individualized Physical Therapy for Chronic Knee Pain

Background: Chronic knee pain is highly prevalent, debilitating, and costly. It can result from maladaptive neuroplastic changes in the central and peripheral nervous systems. Up to 66% of individuals with chronic knee pain do not respond to conservative treatments such as physical therapy (PT) or exercise. The addition of noninvasive brain stimulation, in the form of transcranial direct stimulation (tDCS), to PT has the potential to reverse maladaptive plasticity, as well as improve pain and functional outcomes beyond those seen with PT in isolation. This study investigated the safety, feasibility, acceptability, and efficacy of combining tDCS with PT for individuals with chronic knee pain in an outpatient PT clinic. Methods: In this pragmatic randomized, triple-blinded clinical trial, participants with chronic knee pain were assigned to either the active tDCS or sham tDCS groups, both of which had individualized PT following. The active tDCS group had anodal tDCS (20 minutes) targeting the primary motor cortex of the involved knee. Safety was monitored by recording adverse events, and through a safety questionnaire given to participants with knee pain. Feasibility was evaluated by tracking recruitment, enrollment, and retention. Efficacy was assessed through various clinical pain and functional outcomes before and after five treatment sessions. Acceptability was gauged through questionnaires administered to individuals with chronic knee pain and physical therapists. Results: From a pool of 177 potentially eligible participants with knee pain, a total of 32 individuals enrolled in the study. No serious adverse events occurred, but two participants dropped out, one due to headaches and the other due to personal reasons. The active tDCS group demonstrated significant improvements in pain sensitivity, as measured with pressure pain threshold testing, and quadriceps strength as compared to the sham group. The treatment paradigm was found to be acceptable to both individuals with chronic knee pain and physical therapists. Conclusion: The study findings demonstrate that tDCS combined with individualized PT is safe, feasible, and acceptable. It also provides foundational evidence that tDCS has a strong potential to be used as a neuromodulatory adjunct in a rehabilitation setting.

Author dc:creator

• Mariah Balinski (23292067)

• chronic pain
• knee
• physical therapy
• transcranial direct current stimulation

Statement dc:rights

• In Copyright
• Open Access after 2028-01-01

DOI dc:identifier

https://doi.org/10.25417/uic.31451761.v1

OAI identifier oai:identifier

oai:figshare.com:article/31451761