Analgesic Potential of Light Therapy in Knee Osteoarthritis

Investigation of Light Therapy in the Treatment Of Pain Caused By Osteoarthritis Of The Knee: A One-way Crossover Trial

Managing joint pain is one of the main goals for treating osteoarthritis (OA) and other musculoskeletal disorders. Alleviating chronic pain pharmacologically has several potential drawbacks including diminishing efficacy, toxicity, adverse side-effects, and patient anxiety. Non-pharmacological approaches (eg. weight loss) have also been found to be effective at controlling joint pain and can provide supplementary benefits. The development of efficacious, alternative treatments for arthritis pain which provide analgesia without adverse side-effects would be advantageous.

Recently, preclinical and clinical studies have demonstrated that green ambient light using light-emitting diodes (LEDs) produced profound analgesia in animal models and chronic pain patients. Both migraineurs and fibromyalgia patients have both reported significant reductions in pain following 10 weeks of green LED exposure.

The investigators aim to assess the analgesic potential of green light therapy for people living with knee osteoarthritis. Participants will be asked to keep a pain diary for 4 weeks prior to light intervention. All participants will first use a white LED (20 lux) for 1-2 hours per day in a dark room at home for 10 weeks. Following a 2-week washout period without light use, participants will use a green LED (20 lux) for 1-2 hours per day in a dark room at home for 10 weeks. Following completion of the intervention, the investigator will assess changes in reported pain and quality of life. The investigators hypothesize that participants will have improvements in pain intensity and quality of life following treatment with green LEDs.

Study Overview

• Status: Active, not recruiting
• Conditions: Osteo Arthritis Knee
• Intervention / Treatment: Device: White LED light; Device: Green LED light

Detailed Description

Osteoarthritis (OA) is a progressive joint disease that affects 13% of Canadians. Managing joint pain is one of the main goals for treating OA and other musculoskeletal disorders. Alleviating chronic pain pharmacologically has several potential drawbacks including diminishing efficacy, toxicity, adverse side-effects, and patient anxiety. Current treatments consist mainly of oral nonsteroidal anti-inflammatories which are associated with significant side-effects such as higher risk of gastrointestinal (GI)ulcers and upper GI bleeds. Opioids as well are used but again present the risk that are associated with sedation, constipation and for some individuals substance disorders and addiction. Non-pharmacological treatments for OA pain may be beneficial.

Recently, preclinical and clinical studies have demonstrated that green ambient light using light-emitting diodes (LEDs) produced profound analgesia in chronic pain patients. Migraineurs exposed to this green light therapy (GLT) for 1-2 hours per day for 10 weeks reported a significant reduction in both headache days as well as headache intensity. Similarly, fibromyalgia patients treated with the same conditions reported a significant reduction in average pain intensity. Both patient groups also reported improvements in quality-of-life following treatment as measured by the EQ-5D-5L survey and, importantly, no adverse events were reported. White LEDs were used as a control in both trials and did not provide any analgesic benefit.

In pre-clinical rodent models, activation of the endogenous opioid system appears to be contributing to the analgesic effects of green light therapy. It is unknown if green light therapy may also be beneficial for osteoarthritis pain.

This study is a one-way crossover clinical design to determine whether exposure to green light therapy will improve pain in patients with knee osteoarthritis.

Initially, patients will receive White LED exposure (intensity: 4 lux, 1-2 hr/day), then they will be crossed over to Green LED exposure (wavelength 525nm, intensity: 4 lux, 1-2 hrs/day). The patients will not be told which one is the treatment and which one is the control.

Fourty patients attending the Chronic Pain Management Clinic with knee OA (as defined by the American College of Rheumatology guidelines) will be recruited to the study. Participants will be required to attend 4 visits during the 26 week study. In this study two light treatments will be tested (white LED vs green LED). Following the first clinic visit, we will ask participants to gather baseline pain information for 4 weeks without any light intervention (NRS-PI Pain Scale recorded in a pain diary). During weeks 5-15 participants will be exposed to white LEDs for 1-2 hours per day in a dark room at home, patients will then undergo a 2 week washout period without LED use. Green LEDs will be provided for home use for 1-2 hours per day (in a dark room) for the final 10 weeks. Visits to the clinic will follow the completion of both the white-light and green light treatments. Participants will be required to complete the NRS-PI Pain Scale every day and questionnaires at every visit. Questionnaires include the Brief Pain Inventory Short Form, The Western Ontario and McMaster Universities Arthritis Index (WOMAC), and the EuropQol EQ-5D-5L.

• Study Type: Interventional
• Enrollment (Actual): 46
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Nova Scotia
    • Halifax, Nova Scotia, Canada, B3H1V7
      • NS Health

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 80 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

-Osteoarthritis of the knee according to American College of Rheumatology criteria: Knee pain with 3 of the following: age >50 years, stiffness less than 30 min, crepitus, bony tenderness, bony enlargement, no palpable warmth

• Moderate to severe pain, as defined by an average 7-day pain score of greater than 4.0 on an 11-point numerical rating scale for pain intensity (NRS-PI).
• All concurrent medications taken for any reason stable for 14 days
• Ability to follow protocol with reference to cognitive and situational factors (e.g. stable housing, ability to attend visits)
• Ability to read and write English
• Willing and able to give informed consent

Exclusion Criteria:

• Currently enrolled in other clinical trial involving a pharmaceutical treatment
• Arthroscopic surgery scheduled within 8 months of study initiation

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Crossover Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Sham Comparator: White LED; Participants will be asked to use white LEDs for 1-2 hours/day in a dark room in their home.	Device: White LED light; Participants will be exposed to white LED lights (4 lux) in a dark room for 1-2 hours per day for 10 weeks.; Device: Green LED light; Participants will be exposed to green LED lights (4 lux) in a dark room for 1-2 hours per day for 10 weeks.
Experimental: Green LED; Participants will be asked to use green LEDs for 1-2 hours/day in a dark room in their home.	Device: White LED light; Participants will be exposed to white LED lights (4 lux) in a dark room for 1-2 hours per day for 10 weeks.; Device: Green LED light; Participants will be exposed to green LED lights (4 lux) in a dark room for 1-2 hours per day for 10 weeks.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain Score Diary	Change in mean daily pain diary score from baseline (average pain score over 7 days pre-treatment) to post treatment	24 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Western Ontario and McMaster University Arthritis Index (WOMAC)	Change in WOMAC score from baseline to post treatment	24 weeks
Global impression of change and satisfaction	Using the Global impression of change and satisfaction survey, changes in quality of life will be assessed following treatment	24 weeks
Brief Pain Inventory Short Form	Changes in reported pain will be assessed by comparing baseline and post-treatment responses	24 weeks

Collaborators and Investigators

• Sponsor: Nova Scotia Health Authority
• Investigators: Principal Investigator: Karim Mukhida, MD, PhD, Nova Scotia Health Authority

Study record dates

Study Major Dates

• Study Start (Actual): February 15, 2023
• Primary Completion (Estimated): February 1, 2026
• Study Completion (Estimated): June 1, 2026

Study Registration Dates

• First Submitted: May 26, 2022
• First Submitted That Met QC Criteria: May 26, 2022
• First Posted (Actual): June 1, 2022

Study Record Updates

• Last Update Posted (Actual): August 23, 2024
• Last Update Submitted That Met QC Criteria: August 21, 2024
• Last Verified: August 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Arthritis; Osteoarthritis; Osteoarthritis, Knee
• Other Study ID Numbers: 154679

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No