ABSTRACT
The long-term goal of this project is to improve clinical pain and symptoms for older adults with knee
osteoarthritis (OA) using home-based nonpharmacological approaches. Knee OA is one of the most common
pain conditions among people over 45 years old, and the management of OA pain is challenging because
existing pharmacological approaches often produce significant adverse events, and the treatment benefits may
decrease over time. Also, knee OA pain is characterized by increased pain-related brain activation, possibly
explaining the limited success of existing peripherally based treatments that target the pain locally in the area
of the knee. Therefore, innovative nonpharmacological interventions targeting pain-related brain function are
needed. Two nonpharmacological pain treatments, transcranial direct current stimulation (tDCS) and
mindfulness-based meditation (MBM), have been shown to improve pain-related brain function in older adults
with knee OA. The rationale for the proposed research is that because tDCS promotes neuroplasticity, it may
potentiate the effect of MBM, which also stimulates adaptive changes in the brain. However, no investigations
to date have examined whether remotely supervised tDCS paired with MBM at home can enhance pain-related
brain function and reduce OA-related clinical pain and symptoms. Home-based interventions are critical
because older adults with knee OA have limited mobility, and recent technological advances have created the
potential for home interventions with real-time monitoring through a secure videoconferencing platform. The
central hypothesis is that remotely supervised tDCS paired with MBM at home will decrease clinical pain and
OA-related clinical symptoms, improve physiopsychological pain processing, and increase participant
satisfaction with treatment. This hypothesis will be tested by pursuing the following specific aims: determine the
effects of active tDCS paired with active MBM on clinical pain and OA-related clinical symptoms (specific aim
1); determine the effects of active tDCS paired with active MBM on physiopsychological pain processing
(specific aim 2); and determine the effects of active tDCS paired with active MBM on participant satisfaction
with treatment (specific aim 3). The proposed study will directly investigate the effects of remotely supervised
tDCS paired with MBM at home in 200 older adults with symptomatic knee OA using a double-blind,
randomized, sham-controlled, phase II parallel group (1:1:1:1 for four groups defined by 2x2 factorial design)
design. The proposed research is significant because it is expected to provide valuable insight into an exciting
new modality of nonpharmacological pain self-management that is extremely easy, safe, and noninvasive with
minimal side effects.
