Chronic Pain. Clinical Trial
Official title:
Primary Motor Cortex Plasticity and the Bottom up Effect of Deep Intramuscular Needling Stimulation Therapy (DIMST)in Osteoarthritis Chronic Pain
The aim of this study is to evaluate the cortical excitability in pain of knee
osteoarthritis (OA), as well as the effect of one session of a kind of electroacupuncture
(deep needling intramuscular stimulation therapy - DIMST) in this pain and the cortical
excitability after the intervention.
The hypothesis is that cortical excitability is altered in this condition, confirming the
findings already described in other chronic pain conditions. The investigators also believe
that a session DIMST can reduce pain and alter cortical excitability, restoring its previous
activity will occur from chronic pain.
Recent developments in the treatment of chronic pain have shown that the primary motor
cortex (M1) is an effective target for neural brain stimulation techniques, such as
transcranial magnetic stimulation (TMS). Due to these promising initial results, the
plasticity of M1 has also been investigated as a potential marker for chronic pain. TMS
studies using single or paired pulse shown changes in M1 plasticity in neuropathic pain and
fibromyalgia pain compared to healthy subjects. Thus, there is a decrease in the inhibitory
activity of chronic pain that can take a state as shown uninhibited by measuring TMS indexed
intracortical inhibition (ICI) and cortical silent period (CSP). Based on these experimental
data and clinical studies have been focused on the effects of neuromodulation techniques in
M1 excitability. The techniques used to stimulate the peripheral nervous system was
investigated using different approaches. The DIMST is a therapy applied to treat peripheral
chronic syndromes that may have central components such as myofascial pain. During DIMST,
the needles are applied to the spinal segment associated with nerve roots dermatome
corresponding to the pathology. This treatment can also be effective in the treatment of
diseases that have major peripheral components such as OA. OA is a major cause of suffering
and disability in the elderly, having an inflammatory component, such as a factor that
contributes to the symptoms and progression of the disease. There is evidence that OA could
lead to sensitization central and segmental, but these effects on M1 plasticity and other
central components are not completely known.
Therefore, researchers proposed to evaluate the plasticity of M1 in this chronic pain
condition and also the effect of bottom-up DIMST in pain and cortical excitability.
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Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Outcomes Assessor), Primary Purpose: Treatment