Chronic Pain
Conditions
Keywords
transcranial direct current stimulation, physical exercise, corticospinal projections
Brief summary
Physical exercises are known to reduce chronic pain in elderly individuals by activating the motor system. However, it seems that exercises are not effective for everyone. The investigators believe that elderly individuals with altered corticospinal tract will be those in whom the exercise alone are not sufficient to relieve pain. For those patients, adding an exogenous stimulation of the motor system such as transcranial direct current stimulation (tDCS) would facilitate the corticospinal tract, and consequently, would help exercises to relieve chronic pain. The investigators hypothesize that combining tDCS with the exercises will be more effective than exercises alone, but only in individuals who initially show low corticospinal projections.
Detailed description
Prevalence and intensity of chronic pain increases substantially with age. According to several studies, physical exercises are effective to reduce chronic pain in elderly. However, it seems that exercises are not effective for everyone. One of the hypotheses raised is that the people in whom the exercises have no effect would be those with an alteration of the corticospinal tract. Transcranial direct current stimulation (tDCS) is a non-invasive neurostimulation technique known to facilitate the corticospinal tract when applied over the motor cortex. Elderly suffering from chronic pain will be recruited in this double-blind, parallel-group, randomised control trial. Participants will be randomized to receive exercises combined to real tDCS (5 daily sessions, 2 mA, 20 minutes) or to sham tDCS. Intervention will last 8 weeks at a rate of 3 workouts per week.
Interventions
OTHERtranscranial direct current stimulation
real tDCS sessions
OTHERPhysical exercise
Aerobic exercise and physical training combined with sham tDCS
Sponsors
Université de Sherbrooke
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* To have musculoskeletal chronic pain * Not to change medication and life habits during the study
Exclusion criteria
* People physically active before the study (more then 150 min of moderate to vigorous exercise par week) * To have an uncontrolled cardiovascular disease * To have orthopedic limitation or contraindication to physical exercise * To have contraindication to tDCS * To have contraindication to TMS * To have contraindication to MRI
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Changes in Pain intensity | Before intervention (T1), First week of intervention (T2), Week 4 (T3), Week 8 (T4), Follow-up 1 week after intervention (T5), Follow-up 1 month after intervention (T6) | Pain intensity will be assessed with a pain logbook containing a numerical rating scale from 0 to 10 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Corticospinal excitability (dMRI) | Before intervention, Follow-up 1 week after, Follow-up 1 month after | Corticospinal tract excitability will be assessed diffusion magnetic resonance imaging |
| Functional connectivity | Before intervention, Follow-up 1 week after intervention, Follow-up 1 month after intervention | Functional connectivity will be assessed with functional magnetic resonance imaging |
| McGill pain questionnaire | Before intervention, Follow-up 1 week after intervention, Follow-up 1 month after intervention | McGill pain questionnaire will be used to assess pain in its globality. Score from 0 to 72, higher score means worse outcome. |
| Brief pain inventory | Before intervention, Follow-up 1 week after intervention, Follow-up 1 month after intervention | Brief pain inventory will be used to assess pain in its globality. Score from 0 to 70, higher score means worse outcome |
| Beck depression inventory | Before intervention, Follow-up 1 week after intervention, Follow-up 1 month after intervention | Beck depression inventory will be used to assess pain in its globality. Score from 0 to 39, higher score means worse outcome |
| Corticospinal excitability (TMS) | Before intervention, Follow-up 1 week after, Follow-up 1 month after | Corticospinal tract excitability will be assessed with transcranial magnetic stimulation (TMS) |
| Margolis pain drawing and scoring system | Before intervention, Follow-up 1 week after intervention, Follow-up 1 month after intervention | Margolis pain drawing and scoring system will be used to assess pain in its globality. Score from 0 to 45, higher score means worse outcome |
| Patient global impression of change questionnaire | Before intervention, Follow-up 1 week after intervention, Follow-up 1 month after intervention | patient global impression of change questionnaire will be used to assess pain in its globality. Score from 0 to 18 and a percentage from 0 to 100. Higher scores mean better outcome |
| Tampa questionnaire | Before intervention, Follow-up 1 week after intervention, Follow-up 1 month after intervention | Tampa questionnaire will be used to assess pain in its globality. Score from 0 to 68, higher score means worse outcome |
| Pain catastrophizing scale | Before intervention, Follow-up 1 week after intervention, Follow-up 1 month after intervention | Pain catastrophizing scale will be used to assess pain in its globality. Score from 0 to 52, higher score means worse outcome |
| Beck anxiety inventory | Before intervention, Follow-up 1 week after intervention, Follow-up 1 month after intervention | Beck anxiety inventory will be used to assess pain in its globality. Score from 0 to 63, higher score means worse outcome |
Countries
Canada
Contacts
Primary ContactGuillaume Léonard, PhD. pht
Backup ContactMarie-Philippe HArvey, M.Sc
Outcome results
None listed