ABSTRACTThe long-term goal of this project is to improve clinical pain and symptoms for older adults with kneeosteoarthritis (OA) using home-based nonpharmacological approaches. Knee OA is one of the most commonpain conditions among people over 45 years old and the management of OA pain is challenging becauseexisting pharmacological approaches often produce significant adverse events and the treatment benefits maydecrease over time. Also knee OA pain is characterized by increased pain-related brain activation possiblyexplaining the limited success of existing peripherally based treatments that target the pain locally in the areaof the knee. Therefore innovative nonpharmacological interventions targeting pain-related brain function areneeded. Two nonpharmacological pain treatments transcranial direct current stimulation (tDCS) andmindfulness-based meditation (MBM) have been shown to improve pain-related brain function in older adultswith knee OA. The rationale for the proposed research is that because tDCS promotes neuroplasticity it maypotentiate the effect of MBM which also stimulates adaptive changes in the brain. However no investigationsto date have examined whether remotely supervised tDCS paired with MBM at home can enhance pain-relatedbrain function and reduce OA-related clinical pain and symptoms. Home-based interventions are criticalbecause older adults with knee OA have limited mobility and recent technological advances have created thepotential for home interventions with real-time monitoring through a secure videoconferencing platform. Thecentral hypothesis is that remotely supervised tDCS paired with MBM at home will decrease clinical pain andOA-related clinical symptoms improve physiopsychological pain processing and increase participantsatisfaction with treatment. This hypothesis will be tested by pursuing the following specific aims: determine theeffects of active tDCS paired with active MBM on clinical pain and OA-related clinical symptoms (specific aim1); determine the effects of active tDCS paired with active MBM on physiopsychological pain processing(specific aim 2); and determine the effects of active tDCS paired with active MBM on participant satisfactionwith treatment (specific aim 3). The proposed study will directly investigate the effects of remotely supervisedtDCS paired with MBM at home in 200 older adults with symptomatic knee OA using a double-blindrandomized sham-controlled phase II parallel group (1:1:1:1 for four groups defined by 2x2 factorial design)design. The proposed research is significant because it is expected to provide valuable insight into an excitingnew modality of nonpharmacological pain self-management that is extremely easy safe and noninvasive withminimal side effects.