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Osteoarthritis (OA) is a degenerative disease with a prevalence of up to 30% among adults over 45 years old. Moreover, elderly people over 60 years are more prone to develop a chronification of pain symptomatology. Chronic pain in OA enormously restricts patients' ability to perform their daily activities, eliciting psychological distress and mood alterations, and producing massive socioeconomic consequences. For these reasons, any non-invasive drug-free treatment that decreases chronic pain in OA requires serious evaluation.
This study aims to investigate the effectiveness of noninvasive interoceptive stimulation (affective touch) in treating chronic pain associated with osteoarthritis (OA).
This study aims to investigate the effectiveness of noninvasive interoceptive stimulation (affective touch) in treating chronic pain associated with osteoarthritis (OA).
The current study aims to assess the long-term analgesic efficacy of interoceptive tactile stimulation in patients suffering from chronic moderate-to-severe osteoarthritis (OA) pain. The study will be a randomized, double-blind, sham-controlled crossover trial involving 60 OA patients with moderate-to-severe chronic pain. Patients will be randomly assigned to the treatment or control group and received interoceptive (affective touch) or control stimulation two days a week for 12 weeks. Patient will then undergo to a 4-week washout period, after that they will be assigned to the crossover treatment for another 12 weeks. The study will measure changes in pain and physical function, heart rate variability, as well as inflammatory and anti-inflammatory cytokines and medication intake, assessed at baseline, and at the end of each crossover phase. Follow-up measures will be assessed 4 weeks after the end of each crossover phase. Intermediate outcomes for pain and physical function, heart rate variability and medication intake will also be assessed after 4 and 8 weeks.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| General Practitioner (GP) care plus interoceptive non-invasive tactile stimulation treatment | Experimental | Participants will receive General Practitioner (GP) care and interoceptive non-invasive tactile stimulation (affective touch) for 30 min two times a week for 12 weeks. |
|
| GP care plus sham treatment | Sham Comparator | Participants will receive General Practitioner (GP) care and a sham stimulation for 30 min two times a week for 12 weeks. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Interoceptive stimulation treatment with mechanical stimulation of C-LTMRs afferences | Device | The intervention is a non-invasive interoceptive stimulation (affective touch) delivered to the left volar forearm. The stimulation is delivered using a device with a small tactile probe that touches the skin in a circular motion. The device is designed to induce maximum firing frequency in the peripheral C-Ts nervous afferents, which respond to low-force, low-velocity stimuli, specifically 3 cm/sec, 2.5mN. The stimulation will be delivered in 18 blocks, each consisting of 6 short periods of stimulation of varying durations presented in random order, with pauses of 6 seconds after every single stimulation, the entire stimulation protocol will have a total duration of 30 minutes. |
| Measure | Description | Time Frame |
|---|---|---|
| the pain subscale scores from Western Ontario and McMaster Universities OA Index (WOMAC) | A higher WOMAC score represented worse symptom severity. Measures are assessed in a modified intention-to treat population for all participants randomly assigned to groups and who attended a baseline visit. | the change from baseline to week 12 in the pain subscale scores of the WOMAC |
| the physical function subscale scores of the Western Ontario and McMaster Universities OA Index (WOMAC) | A higher WOMAC score represented worse symptom severity. Measures are assessed in a modified intention-to treat population for all participants randomly assigned to groups and who attended a baseline visit. | Will be the change from baseline to week 12 in the physical function subscale scores of the Western Ontario and McMaster Universities OA Index (WOMAC). |
| the patient global assessment (PGA) of osteoarthritis. | Measures are assessed in a modified intention-to treat population for all participants randomly assigned to groups and who attended a baseline visit. | Will be the change from baseline to week 12 in the patient global assessment (PGA) |
| Measure | Description | Time Frame |
|---|---|---|
| Long term changes of inflammatory cytokine plasmatic levels | Interleukin-10 (IL-10), Tumor necrosis factor alpha or TNF-α, interleukin 1 family of cytokine, IL-1β, Interleukin-6 (IL-6), Interleukin-4 (IL4) | the change from baseline to week 12 |
| Long term changes of stress/pain/anxiety-related hormone plasmatic levels cortisol and oxytocin |
| Measure | Description | Time Frame |
|---|---|---|
| joint pain scores | Pain Numeric Rating Scale (NRS). Minimum score 0 (no pain); maximum score 10 (worst pain imaginable). The higher the score the higher the pain. | the change pre-intervention and immediately after the intervention |
| rescue analgesic medication intake |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Daniele Di Lernia | Catholic University of the Sacred Heart of Milan | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Cosimo Tuena | Milan | Lombardy | 20145 | Italy |
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| ID | Term |
|---|---|
| D059350 | Chronic Pain |
| ID | Term |
|---|---|
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| Sham treatment | Device | In the sham condition, patients will receive a similar stimulation with the interoceptive tactile device, however, the device will be turned on for only 3 seconds every minute, and consequently turned off for 57 seconds. The entire duration of the stimulation will be approximately 30 minutes, similar to the experimental condition. |
|
IL-10 and IL-4 |
| the change from baseline to week 12 |
change of amount of rescue analgesic medication intake (the lower the better) |
| the change from baseline to week 12 |
| change in sympathetic activity | change in sympathetic activity (Low-Frequency power band index) | the change pre-intervention and immediately after the intervention |
| Short term changes of inflammatory cytokine and hormone plasmatic levels | Interleukin-10 (IL-10), Tumor necrosis factor alpha or TNF-α, interleukin 1 family of cytokine or IL-1β, Interleukin-6(IL-6),Interleukin-4 (IL4), cortisol and oxytocin | the change pre-intervention and immediately after the intervention |
| the percentage of patients who responded to Western Ontario and McMaster Universities (WOMAC) | the percentage of patients who responded to treatment according to ≥30% and ≥50% changes at week 12 in the WOMAC pain and physical function subscale scores. | changes at week 12 |
| pain diary | Pain weekly measures will be collected with a pain diary two days a week. In the dairy, patients will report pain ratings on the WOMAC pain subscale, to keep track of sudden variations in the symptomatology (i.e., flares) in the 48 hours preceding the treatment sessions. | two days a week in the 48 hours preceding the treatment sessions |
| change in parasympathetic activity | change in parasympathetic activity (rMSSD index) | the change pre-intervention and immediately after the intervention |
| change in parasympathetic | change in parasympathetic (HighFrequency power band index) | the change pre-intervention and immediately after the intervention |