Dose Dependent Effects of tDCS on Post-Operative Pain
Condition: Total Knee Arthroplasty (Postoperative Pain); Total Hip Arthroplasty(Postoperative Pain)
MeSH terms: Pain, Postoperative
Intervention: 4 Real sessions of Transcranial Direct Current Stimulation; 2 Real Sessions of Transcranial Direct Current Stimulation; 1 Real Session of Transcranial Direct Current Stimulation; Sham Transcranial Direct Current Stimulation
Intervention description: Stimulation of brain areas associated with pain perception using low amplitude direct current of 2mA delivered by electrodes attached to the scalp.; Stimulation of brain areas associated with pain perception using low amplitude direct current of 2mA delivered by electrodes attached to the scalp. 2 real sessions of tDCS and 2 sham.; Stimulation of brain areas associated with pain perception using low amplitude direct current of 2mA delivered by electrodes attached to the scalp. 1 real sessions of tDCS and 3 sham.; Four sessions of sham tDCS; control intervention.
Phase: Phase 1
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Enrollment: 119.0
Sex: All
Minimum age: 19 Years
Maximum age: 90 Years
Healthy volunteers: No
Keywords: total knee arthroplasty; pain; post-surgical pain; opioid; transcranial direct current stimulation; tDCS; brain stimulation; total hip arthroplasty; TKA; THA

Summary:

      The proper control of acute and chronic pain is one of the most important areas in health
      care. Despite the profound advances in neuroscience over the past 20 years, the investigators
      still largely use opiate narcotics, much as was done in the Civil War. Total knee
      arthroplasty (TKA) is one of the most common orthopedic procedures performed 1. While knee
      pain is often a complaint that precedes TKA, the procedure itself is associated with
      considerable post-operative pain lasting days to weeks. Adequate postoperative pain control
      is an important factor in determining recovery time and hospital length of stay. New
      analgesic strategies are needed that can be used adjunctively to existing strategies with the
      potential to reduce reliance on opioid analgesia. Several novel brain stimulation
      technologies including transcranial magnetic stimulation (TMS) and transcranial direct
      current stimulation (tDCS) are beginning to demonstrate promise as treatments for a variety
      of pain conditions. Electricity has no metabolite or other residue, and can be delivered with
      minimal discomfort and without problems associated with drug-drug interactions. In two
      independent preliminary pilot studies, the Investigators have shown that tDCS can reduce
      post-operative PCA use by as much as 46% while simultaneously reducing subjective pain
      ratings. The present study aims to determine the effects of transcranial direct current
      stimulation (tDCS) on post-operative pain, patient-controlled analgesia (PCA) use, and
      post-surgical complications during the 48-hour post-operative period following total knee
      arthroplasty.
    

Eligibility criteria:

        Inclusion Criteria:

        Participants will be 120 patients undergoing TKA or THA surgery at the Ralph H. Johnson
        VAMC in Charleston SC.

          -  Between the ages of 19 and 90

          -  Mentally capable of reading, writing, giving consent, and following instructions

          -  Cleared for and scheduled for unilateral TKA or THA surgery

        Exclusion Criteria:

          -  Implanted medical devices above the waist

          -  Pregnant

          -  History of seizures

          -  Allergic to latex rubber

          -  Psychiatric conditions other than for depression and/or anxiety disorders