Please select the eligibility criteria that correspond to the clinical trial below.
Title: Transcranial Direct Current Stimulation in Older Persons With Knee Pain: Randomized Pilot Study
Brief Summary: The purpose of this research is to study the effects of Transcranial Direct Current Stimulation (tDCS) on clinical pain, mobility disability, and pain sensitivity to gain a better understanding of the factors that cause pain and disability in people with knee osteoarthritis (OA). In particular, people from different ethnic and racial groups may experience OA pain differently which is why the focus will be on older Asian Americans and non-Hispanic whites. It is important to find a reason for such difference so that a better treatment can be found for all OA patients. In addition, the research study will examine if there is any ethnic differences in pain and mobility disability. The investigator hypothesize that Asian Americans will report greater pain and mobility disability than non-Hispanic whites, and that active tDCS will result in improvement in pain and disability compared to sham tDCS.


Options:
A: Inclusion Criteria:

* they have self-reported unilateral or bilateral knee OA pain according to American College of Rheumatology criteria
* they can understand, speak and read English
* they are able to walk for 6-minutes
* they are willing to be randomized to either the intervention or control group
* they are available for five consecutive daily sessions and for a follow-up phone interview each week for three weeks post-stimulation sessions
* they have no plan to change medication regimens for pain throughout the trial
* they are willing and able to provide written informed consent

Exclusion Criteria:

* knee replacement or non-arthroscopic surgery to the affected knee
* serious medical illness, such as uncontrolled hypertension (i.e., Systolic Blood Pressure/Diastolic Blood Pressure of ≥ 150/95), congestive heart failure, pacemaker, or history of acute myocardial infarction
* peripheral neuropathy
* systemic rheumatic disorders, including rheumatoid arthritis, systemic lupus erythematosus, and fibromyalgia
* alcohol/substance abuse
* cognitive impairment (i.e., Mini-Mental Status Exam score ≤ 23)
* history of brain surgery, tumor, seizure, stroke, or intracranial metal implantation
* pregnancy or lactation for females
* hospitalization within the preceding year due to psychiatric illness
B: Inclusion Criteria:

* Patients diagnosed as fibromyalgia according to the American college of rheumatology classification, (ACR) 2010 and referred to any of the above clinics for treatment.

  * Patients must have a mean pain score ≥ 4 on a 10-point visual analog scale (VAS) during the 2 weeks preceding the clinical trial.
  * Patients from nearby districts to ensure good availability for follow-up.

Exclusion Criteria:

* Patients refused to participate in the trial.
* Patients with any uncontrolled clinical disease (as evaluated by each patient's clinician), such as any associated rheumatologic, thyroid, cardiovascular, pulmonary, hematologic, or renal diseases, pregnancy, lactation, and neuropsychiatric disorders.
C: Inclusion Criteria:

* age 18-80,
* meet ACR criteria for FM for more than 6 months,
* may or may not have a diagnosis of major depressive disorder (not bipolar) past or present,
* Current major depressive episode must be without psychotic features
* Not be on medication known to increase risk of TMS-induced seizures
* No prescription medication changes in the previous 4 weeks with agreement not to change during the treatment course (2 weeks) and 2 weeks thereafter
* No history of epilepsy or stroke or recent head trauma (LOC \> 5 minutes) within the past 6 months
* African Americans will be initially sought out for study, however the recruitment may extend to include Caucasian and Hispanic subjects to carry out the study.

Exclusion Criteria:

* Primary, current diagnosis of schizophrenia
* Other (non-mood disorder) psychosis
* Mental retardation
* Substance dependence or abuse within the past 6 months (except nicotine)
* Psychotic features in this episode, dementia, or delirium
* Contraindication to rTMS
* Increased intracranial pressure
* Brain surgery, or head trauma with loss of consciousness for \> 15 minutes
* Implanted electronic device
* Metal in the head, or pregnant
* Has an active autoimmune, endocrine, viral, or vascular disorder affecting the brain or unstable cardiac disease
* Uncontrolled hypertension, or severe renal or liver insufficiency
* Unstable and active suicidal intent or plan
* History of attempt requiring medical hospitalization within in the past 6 months
* -currently an involuntary inpatient on a psychiatric ward.
D: Inclusion Criteria:

* Over 18 years of age
* History of moderate to severe sublesional pain

Exclusion Criteria:

* Active alcohol or drug dependence, as self-reported
* A history of bipolar disorder or psychosis, as self-reported
* Inability to travel to the study site,
* Current use of any of the following anti-epileptic medications or dopaminergic medications known to reduce or inhibit the benefits of tDCS treatment \[53\]: carbamazepine, oxcarbazepine, phenytoin, ropinirole (Requip), pramipexole (Mirapex), and cabergoline (Dostinex),
* The following contradictions to tDCS: implanted metal plates in the head, or deep brain stimulator (spinal cord implants, including baclofen pumps, are not a contraindication as cranial currents do not reach the spinal cord \[24\]).
* Pregnancy at time of enrollment
* Current use of ventilator.

Answer: A