scholarly journals Safety and feasibility of transcranial direct current stimulation (tDCS) combined with sensorimotor retraining in chronic low back pain: a protocol for a pilot randomised controlled trial

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e013080 ◽  
Author(s):  
Adam Louis Ouellette ◽  
Matthew B Liston ◽  
Wei-Ju Chang ◽  
David M Walton ◽  
Benedict Martin Wand ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Direct Current ◽  
Chronic Low Back Pain ◽  
Transcranial Direct Current Stimulation ◽  
Primary Motor Cortex ◽  
Controlled Trial ◽  
Pilot Trial ◽  
Low Back ◽  
Direct Current Stimulation

IntroductionChronic low back pain (LBP) is a common and costly health problem yet current treatments demonstrate at best, small effects. The concurrent application of treatments with synergistic clinical and mechanistic effects may improve outcomes in chronic LBP. This pilot trial aims to (1) determine the feasibility, safety and perceived patient response to a combined transcranial direct current stimulation (tDCS) and sensorimotor retraining intervention in chronic LBP and (2) provide data to support a sample size calculation for a fully powered trial should trends of effectiveness be present.Methods and analysisA pilot randomised, assessor and participant-blind, sham-controlled trial will be conducted. Eighty participants with chronic LBP will be randomly allocated to receive either (1) active tDCS + sensorimotor retraining or (2) sham tDCS + sensorimotor retraining. tDCS (active or sham) will be applied to the primary motor cortex for 20 min immediately prior to 60 min of supervised sensorimotor retraining twice per week for 10 weeks. Participants in both groups will complete home exercises three times per week. Feasibility, safety, pain, disability and pain system function will be assessed immediately before and after the 10-week intervention. Analysis of feasibility and safety will be performed using descriptive statistics. Statistical analyses will be conducted based on intention-to-treat and per protocol and will be used to determine trends for effectiveness.Ethics and disseminationEthical approval has been gained from the institutional human research ethics committee (H10184). Written informed consent will be provided by all participants. Results from this pilot study will be submitted for publication in peer-reviewed journals.Trial registration numberACTRN12616000624482

scholarly journals Transcranial Direct Current Stimulation for Affective Symptoms and Functioning in Chronic Low Back Pain: A Pilot Double-Blinded, Randomized, Placebo-Controlled Trial

Pain Medicine ◽  
2018 ◽  
Vol 20 (6) ◽  
pp. 1166-1177 ◽  
Author(s):  
Timothy Y Mariano ◽  
Frederick W Burgess ◽  
Marguerite Bowker ◽  
Jason Kirschner ◽  
Mascha van’t Wout-Frank ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Direct Current ◽  
Chronic Low Back Pain ◽  
Transcranial Direct Current Stimulation ◽  
Controlled Trial ◽  
Low Back ◽  
Direct Current Stimulation ◽  
Affective Symptoms ◽  
Double Blinded

scholarly journals Medial Prefrontal Transcranial Direct Current Stimulation Aimed to Improve Affective and Attentional Modulation of Pain in Chronic Low Back Pain Patients

2021 ◽  
Vol 10 (4) ◽  
pp. 889
Author(s):  
Megan E. McPhee ◽  
Thomas Graven-Nielsen
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Direct Current ◽  
Chronic Low Back Pain ◽  
Transcranial Direct Current Stimulation ◽  
Pilot Trial ◽  
Pain Modulation ◽  
Low Back ◽  
Pain Mechanisms ◽  
Direct Current Stimulation

Chronic low back pain (CLBP) is often without clear underlying pathology. Affective disturbance and dysfunctional pain mechanisms, commonly observed in populations with CLBP, have, therefore, been suggested as potential contributors to CLBP development and maintenance. However, little consensus exists on how these features interact and if they can be targeted using non-invasive brain stimulation. In this pilot trial, 12 participants completed two phases (Active or Sham) of high-definition transcranial direct current stimulation (HD-tDCS) to the medial prefrontal cortex, applied for 20 min on three consecutive days. Clinical pain ratings, questionnaires, and sensitivity to painful cuff pressure were completed at baseline, then 4 trials of conditioned pain modulation (CPM; alone, with distraction using a Flanker task, with positive affect induction, and with negative affect induction using an image slideshow) were performed prior to HD-tDCS on Day 1 and Day 4 (24 h post-HD-tDCS). At baseline, attentional and affective manipulations were effective in inducing the desired state (p < 0.001) but did not significantly change the magnitude of CPM-effect. Active HD-tDCS was unable to significantly alter the magnitude of the shift in valence and arousal due to affective manipulations, nor did it alter the magnitude of CPM under any basal, attentional, or affective manipulation trial significantly on Day 4 compared to sham. The CPM-effect was greater across all manipulations on Day 1 than Day 4 (p < 0.02) but also showed poor reliability across days. Future work is needed to expand upon these findings and better understand how and if HD-tDCS can be used to enhance attentional and affective effects on pain modulation.

Is transcranial direct current stimulation (tDCS) effective for chronic low back pain? A systematic review and meta-analysis

2020 ◽  
Vol 127 (9) ◽  
pp. 1257-1270
Author(s):  
Mohammad Alwardat ◽  
Antonio Pisani ◽  
Mohammad Etoom ◽  
Roberta Carpenedo ◽  
Elisabetta Chinè ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Direct Current ◽  
Chronic Low Back Pain ◽  
Transcranial Direct Current Stimulation ◽  
Meta Analysis ◽  
Low Back ◽  
Direct Current Stimulation

scholarly journals Transcranial direct current stimulation for nonspecific low back pain: double-blind randomized sham-controlled trial

2019 ◽  
Vol 23 (3) ◽  
pp. 4-11 ◽  
Author(s):  
Zahra Rezasoltani ◽  
Sirous Azizi ◽  
Sharif Najafi ◽  
Samaneh Sedighi ◽  
Maysam Elahi Movahed ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Controlled Trial ◽  
Low Back ◽  
Double Blind ◽  
Direct Current Stimulation ◽  
Change In Mean ◽  
Stimulation Group

Introduction: Low back pain is recognized as a major cause of morbidity worldwide. Between 70 and 80% of adults experience at least one occasion of low back pain with duration of 3 months or longer in their lifetime. Aside from the classic treatment methods, there are other new techniques yet to be clinically investigated. Transcranial direct current stimulation (tDCS) has been reported to alleviate pain by affecting the central nervous system. To date only a small number of studies have been published on the effects of tDCS on chronic low back pain. Some of these were pilot studies and others were low-powered in terms of their inference. Therefore the clinical application of tDCS requires further careful evaluation. Objective: To assess the efficacy of transcranial direct current stimulation for treatment of chronic nonspecific low back pain. Materials and methods: We carried out a double-blind randomized sham-controlled trial in a University Hospital. In total 70 people (15 women) with low back pain were randomized to either active or sham stimulation. The primary outcome was intensity of low back pain on the Visual Analog Scale. We also used the Oswestry Disability Questionnaire to evaluate the effects of back pain on daily activities. For the active stimulation group we administered 2 mA tDCS, 20 minutes for each session, once daily, 5 days per week for 2 weeks, totaling 10 sessions. For the sham stimulation group a similar program was followed with no stimulation. Both groups used analgesic medication. Results: Within-group analysis showed that an initial decrease in pain intensity was significant in both groups (both p < 0.001). However, pain reduction became stable only in the active treatment group. There was a significant difference in the pattern of change in mean pain scores in favor of tDCS (p < 0.001). Active treatment also significantly reduced disability scores (all p values < 0.001), whereas participants in the sham treatment group did not experience functional recovery. Mixed ANOVA indicated that the pattern of change in mean scores of disability differed between the two groups throughout the study course, in favor of active stimulation (p < 0.001). Conclusion: Transcranial direct current stimulation is an effective and safe initial treatment for chronic nonspecific low back pain, and the benefits remain for at least several months.

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