Randomized pilot of rTMS for knee arthritis pain and depression

Is this trial a fit for you?

A plain-English reading of the study's rules. Only the study team can confirm whether you qualify.

What this trial studies

This randomized early-phase pilot delivers sequential, multi-target rTMS to the primary motor cortex (M1) and left dorsolateral prefrontal cortex (l-DLPFC) alongside a twice-weekly Tai Chi program over three months. Participants are adults 50 and older with symptomatic or radiographic knee osteoarthritis and persistent depressive symptoms. The trial measures changes in pain, function, and mood to determine feasibility, tolerability, and early signals of clinical benefit. The study is conducted at UCLA and includes telehealth components for some study activities.

Why it matters

Who can join: the full rules

Inclusion Criteria:

* • Age 50 or years older.

  * Chronic pain as indicated by complaints of pain in one or more body regions for 6 months or more. Participants who meet at least one of the following criteria for Osteoarthritis (OA)

    * Fulfills the American College of Rheumatology (ACR) criteria for symptomatic knee OA and had radiographic evidence of tibiofemoral or patellofemoral OA (defined as the presence of a definite osteophyte in the tibiofemoral compartment and/or the patellofemoral compartment.
    * Knee pain for \>- 3 months and on most days of the past month
    * Patient PROMIS Pain Interference score \>=40 (100 mm VAS);
    * Access to computer or device for telehealth delivery;
    * Able to walk without cane or assistance.
  * Psychological distress expressed as depression: Persistent depressive symptomatology (Beck Depression Inventory)\>20 in two consecutive screenings within 2-3 weeks.
  * Willingness to complete the 3-month study, including twice-a-week Tai Chi sessions and rTMS, with additional 6 and 12 month follow up
  * Approval to participate in program by patient's primary care provider or another member of their medical team (e.g. cardiologist).
  * Ability to pass the Physical Activity Readiness Questionnaire (PAR-Q) administered in the telephone screening.
  * Internet access \>No contraindications to rTMS

Exclusion Criteria:

* • Change in psychotropic or pain medication during the past four months. This will minimize the amount of symptom change due to medication alterations.

  * A current diagnosis of mania, hypomania, unstable bipolar disorder, psychotic disorder or a history of psychosis, as noted in electronic medical record.
  * Dementia, neurological disease, cancer, cardiovascular disease, metabolic disease, renal disease, liver disease, or other serious medical conditions limiting ability to participate in the Tai Chi or Exercise programs, as determined by primary care physicians.
  * No current medical conditions that limit ability to participate safely in moderate exercise.
  * Meets criteria for alcohol or drug dependence within the past three months.
  * Currently practicing Tai Chi

Where it's running

• UCLA Semel Institute - Neuropsychiatric Institute (NPI)
  Los Angeles, California, United States Recruiting

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How to take part

1. Review the eligibility criteria above with your treating physician.
2. Check the official listing on ClinicalTrials.gov for the latest contact details and recruitment status.
3. Contact the study coordinator or principal investigator to ask for pre-screening. Pre-screening is free and never obligates you to enroll.