# tDCS Combined with a Brief Cognitive Intervention to Reduce Perioperative Pain and Opioid Requirements in Veterans

> **NIH VA I01** · RALPH H JOHNSON VA MEDICAL CENTER · 2022 · —

## Abstract

The proper control of pain is one of the most important areas in health care. We still rely heavily on opioid
narcotics for acute and chronic pain control despite growing evidence of their risks and lack of strong efficacy.
In surgical populations, where opioid prescribing is common and often believed to be good practice, the
amount and duration of post-operative opioid prescriptions are strongly related to subsequent opioid misuse,
and perioperative opioid use is associated with increased morbidity and mortality. Total knee arthroplasty
(TKA) is one of the most common orthopaedic procedures performed. While knee pain is often a complaint that
precedes TKA, the procedure itself is associated with considerable post-operative pain lasting days to weeks.
Data suggest that adequate post-operative pain control in this population is an important factor in determining
surgical outcomes, recovery time, and hospital length of stay. While the technology associated with the TKA
procedure itself has developed rapidly in the past several years, post-operative pain management techniques
have not changed substantially in several decades, and despite the currently employed pain-management
strategies, patients still report considerable post-operative pain, and often struggle to complete post-operative
physical therapy regimens. New analgesic strategies are needed that can be used adjunctively with existing
strategies that have the potential to reduce reliance on opioid analgesia, and reduce post-operative pain.
Several novel brain stimulation technologies including transcranial direct current stimulation (tDCS) are
beginning to demonstrate promise as treatments for a variety of pain conditions including perioperative pain. In
a series of recent studies, the PI has shown that tDCS can reduce post-operative opioid use by as much as
43% while simultaneously reducing subjective pain ratings. This recent scientific work (and the work of others)
suggests that stimulating pain-modulating areas of the human cortex with tDCS has the potential to yield
meaningful analgesic effects and reduce post-operative opioid consumption with minimal risks or side-effects.
Another non-pharmacologic approach to pain-management with minimal risks and good potential benefit is
cognitive behavioral therapy for pain (CBT-P). CBT-P has consistently demonstrated solid empirical support as
an effective treatment for chronic pain, but it is less well-studied in perioperative settings. Nonetheless, a few
small studies have demonstrated that brief cognitive-behavioral interventions hold promise as adjunctive post-
operative pain management strategies, but more work is needed. Interestingly, accumulating data from our
group suggest that tDCS of the prefrontal cortex may augment the analgesic effects of cognitive-behavioral
(CB) interventions for acute pain. When combined with a brief cognitive-behavioral intervention for acute
pain, tDCS appears to enhance the analgesic benefits of the cognitive-b...

## Key facts

- **NIH application ID:** 10417011
- **Project number:** 5I01CX001996-03
- **Recipient organization:** RALPH H JOHNSON VA MEDICAL CENTER
- **Principal Investigator:** Jeffrey J Borckardt
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2020-01-01 → 2024-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10417011

## Citation

> US National Institutes of Health, RePORTER application 10417011, tDCS Combined with a Brief Cognitive Intervention to Reduce Perioperative Pain and Opioid Requirements in Veterans (5I01CX001996-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10417011. Licensed CC0.

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