About
Scope & Aims
Editorial office
Editorial board
Ethical standards and procedures
Abstracting and indexing
Contact
Articles & Issues
Current issue
Articles in press
Archive
For Authors
General rules
Ethics in publishing
Guide for authors
Templates
Publication charge
For Reviewers
Our reviewers
Ethics in publishing
Guide for reviewers
Books and Events
Books
Events
REVIEW PAPER
Effectiveness of transcranial direct current stimulation on pain and function in knee osteoarthritis: a systematic review with meta-analysis based on PRISMA guidelines
1
Department of Physiotherapy, Guru Jambheshwar University of Science and Technology, Hisar, India
Submission date: 2020-02-18
Acceptance date: 2020-05-11
Publication date: 2021-06-21
Physiother Quart. 2021;29(2):89-95
KEYWORDS
TOPICS
ABSTRACT
Introduction:
To evaluate the effectiveness of transcranial direct current stimulation (tDCS) on pain and quality of life in patients with knee osteoarthritis (OA).
Methods:
The meta-analysis data source were PubMed (MEDLINE) and Cochrane (Central). Randomized controlled trials comparing active tDCS (in combination with other interventions or alone in knee OA patients) with sham tDCS published in English till July 2019 were analysed. The outcome measures were pain intensity (visual analogue scale and numeric rating scale) and quality of life (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]). Mean difference with 95% confidence interval for the active tDCS and sham groups were investigated.
Results:
Four articles with 171 patients were included in the qualitative systematic review and 2 articles with 55 patients were included in the quantitative meta-analysis. The results revealed a statistically significant reduction in pain (visual analogue scale) in the active tDCS group compared with the sham group (Z = 7.32, p < 0.00001) and a significant improvement in WOMAC scores (Z = 2.31, p = 0.02), with high heterogeneity of 83%.
Conclusions:
There is a significant improvement in pain and function in patients with knee OA after the application of active tDCS either alone or in combination. However, more studies are required to confirm the effectiveness of tDCS in knee OA. Owing to the promising results of tDCS in various pain conditions and in knee OA, it can be seen as a future tool for managing pain in the field of physiotherapy.
To evaluate the effectiveness of transcranial direct current stimulation (tDCS) on pain and quality of life in patients with knee osteoarthritis (OA).
Methods:
The meta-analysis data source were PubMed (MEDLINE) and Cochrane (Central). Randomized controlled trials comparing active tDCS (in combination with other interventions or alone in knee OA patients) with sham tDCS published in English till July 2019 were analysed. The outcome measures were pain intensity (visual analogue scale and numeric rating scale) and quality of life (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]). Mean difference with 95% confidence interval for the active tDCS and sham groups were investigated.
Results:
Four articles with 171 patients were included in the qualitative systematic review and 2 articles with 55 patients were included in the quantitative meta-analysis. The results revealed a statistically significant reduction in pain (visual analogue scale) in the active tDCS group compared with the sham group (Z = 7.32, p < 0.00001) and a significant improvement in WOMAC scores (Z = 2.31, p = 0.02), with high heterogeneity of 83%.
Conclusions:
There is a significant improvement in pain and function in patients with knee OA after the application of active tDCS either alone or in combination. However, more studies are required to confirm the effectiveness of tDCS in knee OA. Owing to the promising results of tDCS in various pain conditions and in knee OA, it can be seen as a future tool for managing pain in the field of physiotherapy.
REFERENCES (31)
1.
Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M, et al. The global burden of hip and knee osteoarthritis: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(7):1323–1330; doi: 10.1136/annrheumdis-2013-204763.
2.
Pal CP, Singh P, Chaturvedi S, Pruthi KK, Vij A. Epidemiology of knee osteoarthritis in India and related factors. Indian J Orthop. 2016;50(5):518–522; doi: 10.4103/0019-5413.189608.
3.
Kulandaivelan S, Tigdania N, Ateef M, Chaturvedi R, Joshi S, Malik A, et al. Prevalence of knee pain and its correlates with specific emphasis on CVD risk factors in Hisar urban population. Int J Clin Rheumatol. 2017;12(4):91–96.
4.
Howard MA, Sanders D, Krause K, O’Muircheartaigh J, Fotopoulou A, ZelayaF, et al. Alterations in resting-state regional cerebral blood flow demonstrate ongoing pain in osteoarthritis: an arterial spin-labeled magnetic resonance imaging study. Arthritis Rheum. 2012;64(12):3936–3946; doi: 10.1002/art.37685.
5.
Mao CP, Bai ZL, Zhang XN, Zhang QJ, Zhang L. Abnormal subcortical brain morphology in patients with knee osteoarthritis: a cross-sectional study. Front Aging Neurosci. 2016;8:3; doi: 10.3389/fnagi.2016.00003.
6.
Wood PB. Variations in brain gray matter associated with chronic pain. Curr Rheumatol Rep. 2010;12(6):462–469; doi: 10.1007/s11926-010-0129-7.
7.
Latremoliere A, Woolf CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain. 2009;10(9):895–926; doi: 10.1016/j.jpain.2009.06.012.
8.
Finan PH, Buenaver LF, Bounds SC, Hussain S, Park RJ, Haque UJ, et al. Discordance between pain and radiographic severity in knee osteoarthritis: findings from quantitative sensory testing of central sensitization. Arthritis Rheum. 2013;65(2):363–372; doi: 10.1002/art.34646.
9.
Rakel B, Vance C, Zimmerman MB, Petsas-Blodgett N, Amendola A, Sluka KA. Mechanical hyperalgesia and reduced quality of life occur in people with mild knee osteoarthritis pain. Clin J Pain. 2015;31(4):315–322; doi: 10.1097/AJP.0000000000000116.
10.
Neogi T, Guermazi A, Roemer F, Nevitt MC, Scholz J, Arendt-Nielsen L, et al. Association of joint inflammation with pain sensitization in knee osteoarthritis: the Multicenter Osteoarthritis Study. Arthritis Rheumatol. 2016;68(3):654–661; doi: 10.1002/art.39488.
11.
Gwilym SE, Keltner JR, Warnaby CE, Carr AJ, Chizh B, Chessell I, et al. Psychophysical and functional imaging evidence supporting the presence of central sensitization in a cohort of osteoarthritis patients. Arthritis Rheum. 2009;61(9):1226–1234; doi: 10.1002/art.24837.
12.
Hiramatsu T, Nakanishi K, Yoshimura S, Yoshino A, Adachi N, Okamoto Y, et al. The dorsolateral prefrontal network is involved in pain perception in knee osteoarthritis patients. Neurosci Lett. 2014;581:109–114; doi: 10.1016/j.neulet.2014.08.027.
13.
Sofat N, Smee C, Hermansson M, Homward M, Baker EH, Howe FA, et al. Functional MRI demonstrates pain perception in hand osteoarthritis has features of central pain processing. J Biomed Graph Comput. 2013;3(4):10.5430/jbgc.v3n4p20; doi: 10.5430/jbgc.v3n4p20.
14.
Kuchinad A, Schweinhardt P, Seminowicz DA, Wood PB, Chizh BA, Bushnell MC. Accelerated brain gray matter loss in fibromyalgia patients: premature aging of the brain? J Neurosci. 2007;27(15):4004–4007; doi: 10.1523/JNEUROSCI.0098-07.2007.
15.
Schmidt-Wilcke T, Gänssbauer S, Neuner T, Bogdahn U, May A. Subtle grey matter changes between migraine patients and healthy controls. Cephalalgia. 2008;28(1):1–4; doi: 10.1111/j.1468-2982.2007.01428.x.
16.
Schabrun SM, Chipchase LS. Priming the brain to learn: the future of therapy? Man Ther. 2012;17(2):184–186; doi: 10.1016/j.math.2011.12.001.
17.
Romero Lauro LJ, Rosanova M, Mattavelli G, Convento S, Pisoni A, Opitz A, et al. TDCS increases cortical excitability: direct evidence from TMS-EEG. Cortex. 2014;58:99–111; doi: 10.1016/j.cortex.2014.05.003.
18.
Nitsche MA, Liebetanz D, Tergau F, Paulus W. Modulation of cortical excitability by transcranial direct current stimulation [in German]. Nervenarzt. 2002;73(4):332–335; doi: 10.1007/s00115-002-1272-9.
19.
Alonzo A, Brassil J, Taylor JL, Martin D, Loo CK. Daily transcranial direct current stimulation (tDCS) leads to greater increases in cortical excitability than second daily transcranial direct current stimulation. Brain Stimul. 2012;5(3):208–213; doi: 10.1016/j.brs.2011.04.006.
20.
Marlow NM, Bonilha HS, Short EB. Efficacy of transcranial direct current stimulation and repetitive transcranial magnetic stimulation for treating fibromyalgia syndrome: a systematic review. Pain Pract. 2013;13(2):131–145; doi: 10.1111/j.1533-2500.2012.00562.x.
21.
O’Connell NE, Cossar J, Marston L, Wand BM, Bunce D, De Souza LH, et al. Transcranial direct current stimulation of the motor cortex in the treatment of chronic nonspecific low back pain: a randomized, double-blind exploratory study. Clin J Pain. 2013;29(1):26–34; doi: 10.1097/AJP.0b013e318247ec09.
22.
Chaturvedi R, Kulandaivelan S, Malik M, Joshi S. Effect of transcranial direct current stimulation (TDCS) on pain in fibromyalgia – systematic review based on Prisma guidelines. Int J Physiol Nutr Phys Educ. 2018;3(2):858–862.
23.
Hurley MV, Bearne LM. Non-exercise physical therapies for musculoskeletal conditions. Best Pract Res Clin Rheumatol. 2008;22(3):419–433; doi: 10.1016/j.berh.2008.01.001.
24.
Larmer PJ, Reay ND, Aubert ER, Kersten P. Systematic review of guidelines for the physical management of osteoarthritis. Arch Phys Med Rehabil. 2014;95(2):375–389; doi: 10.1016/j.apmr.2013.10.011.
25.
Teo PL, Hinman RS, Egerton T, Dziedzic KS, Bennel KL. Identifying and prioritizing clinical guideline recommendations most relevant to physical therapy practice for hip and/or knee osteoarthritis. J Orthop Sports Phys Ther. 2019;49(7):501–512; doi: 10.2519/jospt.2019.8676.
26.
Chang W-J, Bennell KL, Hodges PW, Hinman RS, Young CL, Buscemi V, et al. Addition of transcranial direct current stimulation to quadriceps strengthening exercise in knee osteoarthritis: a pilot randomised controlled trial. PLoS One. 2017;12(6):e0180328; doi: 10.1371/journal.pone.0180328.
27.
Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29(8):1039–1049; doi: 10.1002/art.1780290816.
28.
Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52(6):377–384; doi: 10.1136/jech.52.6.377.
29.
Ahn H, Woods AJ, Kunik ME, Bhattacharjee A, Chen Z, Choi E, et al. Efficacy of transcranial direct current stimulation over primary motor cortex (anode) and contralateral supraorbital area (cathode) on clinical pain severity and mobility performance in persons with knee osteoarthritis: an experimenter- and participant-blinded, randomized, sham-controlled pilot clinical study. Brain Stimul. 2017;10(5):902–909; doi: 10.1016/j.brs.2017.05.007.
30.
Ahn H, Suchting R, Woods AJ, Miao H, Green C, Cho RY, et al. Bayesian analysis of the effect of transcranial direct current stimulation on experimental pain sensitivity in older adults with knee osteoarthritis: randomized sham-controlled pilot clinical study. J Pain Res. 2018;11:2071–2082; doi: 10.2147/JPR.S173080.
31.
Da Graca-Tarragó M, Lech M, Angoleri LDM, Santos DS, Deitos A, Brietzke AP, et al. Intramuscular electrical stimulus potentiates motor cortex modulation effects on pain and descending inhibitory systems in knee osteoarthritis: a randomized, factorial, sham-controlled study. J Pain Res. 2019;12:209–221; doi: 10.2147/JPR.S181019.
Share
RELATED ARTICLE
| eISSN: | 2544-4395 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
