Affiliations: [a] Departament of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Murcia, Spain | [b] Rehabilitation Service, Morales Meseguer University Hospital, Murcia, Spain | [c] Center for Translational Research in Physical Therapy (CEIT), Department of Pathology and Surgery, Faculty of Medicine, University Miguel Hernández, Alicante, Spain
Correspondence:
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Corresponding author: Jose Antonio Lozano-Meca, Edificio Departamental-Laib, University of Murcia, Campus de Ciencias de la Salud, Carretera Buenavista s/n 30120, El Palmar, Murcia, Spain. E-mail: joseantonio.lozano@um.es.
Abstract: BACKGROUND: Knee osteoarthritis often leads to chronic pain that frequently becomes disabling.Osteoarthritis has been linked to maladaptive plasticity in the brain, which can contribute to chronic pain. Therapies including neuromodulation and peripheral electrical stimulation are used to counteract the maladaptive plasticity of the brain. OBJECTIVE: To determine the efficacy of the addition of tDCS and TENS to an education and exercise program in reducing pain. METHODS: Over a 2-week study period, 60 participants will complete an exercise and educational intervention. Eligible participants accepting to participate will be subsequently randomized into one of the three treatment groups: 1) Active Transcranial Direct Current Stimulation (tDCS) and active Transcutaneous Electrical Nerve Stimulation (TENS); 2) Active tDCS and sham TENS; 3) Sham tDCS and sham TENS. RESULTS: The primary outcome will be subjective pain intensity. Secondary outcomes: quality of life, physical function, central sensitization, and pain adjuvants (uncertainty, catastrophizing kinesiophobia, adverse events). CONCLUSION: This clinical trial will provide data on the effect that the addition of tDCS and/or TENS to an education and exercise program may have to counteract maladaptive plastic changes and improve the benefits of exercises, and whether the combination of both neuromodulator techniques may have a higher magnitude of effect.
