| Objective: To observe the improvement of pain and knee joint’s function in patients with knee osteoarthritis treated with transcranial direct current stimulation.By analyzing the changes of quantitative sensory testing before and after treatment,the central analgesic mechanism of tDCS was discussed.At the same time,the analgesic effect of tDCS was continuously evaluated by follow-up after treatment.Methods: From January 2022 to April 2022,42 patients who met the diagnostic criteria of KOA established by American College of Rheumatology and European League Against Rheumatism were recruited.42 patients were randomly divided into experimental group and control group,and one case was shed in each of the two groups during the experiment.Finally,each group included 20 patients.The experimental group was treated with active tDCS,while the control group was treated with sham tDCS.The patients in the experimental group received constant current intensity of 2m A stimulation once a day,each time 20 min for 2 weeks.The electrodes in the control group were placed in the same position.The control group patients received only 15 seconds of 2m A current stimulation provided at the beginning and end of treatment to simulate the somatosensory perception of real stimulation,each time 20 min for 2 weeks.The Visual analogue scale(VAS),Western Ontario and Mc Master University Osteoarthritis Index(WOMAC index),Pressure pain threshold(PPT)and Conditioned pain modulation(CPM)of the patellar center of the affected knee and the distal radioulnar joint of the affected knee were evaluated before treatment,2 weeks and 4 weeks after treatment in both groups.The adverse reactions occurred during the treatment and follow-up were recorded.Results:1.Before receiving tDCS treatment,the basic clinical data of age,sex,body mass index and course of disease between the two groups were compared.There was no significant difference between the two groups(P>0.05).2.Before treatment,there was no significant difference in VAS score between the two groups.Compared with those before treatment in the same group,the VAS scores of patients in the experimental group at 2 and 4 weeks after treatment were markedly lower than those before treatment(P<0.05),while those in the control group had no significant difference at 2 and 4 weeks after treatment(P>0.05).Compared with the control group,the VAS score was markedly lower in the experimental group than that in the control group at 2 and 4 weeks after treatment(P<0.05).3.Before treatment,there was no significant difference in WOMAC score between the two groups.Compared with those before treatment in the same group,the WOMAC scores of patients in the experimental group at 2 and 4 weeks after treatment were markedly lower than those before treatment(P<0.05),while those in the control group had no significant difference at 2 and 4 weeks after treatment(P>0.05).Compared with the control group,the WOMAC score was markedly lower in the experimental group than that in the control group at 2 and 4 weeks after treatment(P<0.05).4.Before treatment,there was no significant difference in PPT between the two groups.Compared with those before treatment in the same group,the PPT of the patellar center of the affected knee and the distal radioulnar joint on the same side of the affected knee in the experimental group at 2 and 4 weeks after treatment were markedly higher than those before treatment(P < 0.05).In the control group,the PPT of the patellar center of the affected knee and the distal radioulnar joint on the same side of the affected knee had no significant difference at 2 and 4 weeks after treatment(P > 0.05).Compared with the control group at the same time,the PPT was statistically higher in the experimental group than that in the control group at 2 and 4 weeks after treatment(P<0.05).5.Before treatment,there was no significant difference in CPM between the two groups.Compared with those before treatment in the same group,the CPM of the patellar center of the affected knee and the distal radioulnar joint on the same side of the affected knee in the experimental group at 2 and 4 weeks after treatment were markedly higher than those before treatment(P<0.05).In the control group,the CPM of the patellar center of the affected knee and the distal radioulnar joint on the same side of the affected knee had no significant difference at 2 and 4 weeks after treatment(P > 0.05).Compared with the control group at the same time,the CPM was statistically higher in the experimental group than that in the control group at 2 and 4 weeks after treatment(P<0.05).Conclusion: tDCS can effectively relieve chronic pain and improve knee joint function in patients with KOA.After treatment,the pain relief of patients with KOA can last for 2weeks,and the analgesic effect of tDCS has a lasting effect.tDCS is expected to be a safe and effective novel treatment for the clinical management of chronic pain in KOA. |
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