No Effect of a Single Session of Transcranial Direct Current Stimulation on Experimentally Induced Pain in Patients with Chronic Low Back Pain – An Exploratory Study

Backgroud: Low back pain (LBP) has been associated with severe impairments, primarily related to activities of daily living, functional ability and quality of life. A multimodal approach to pain management, such as transcranial direct current stimulation (tDCS) and peripheral electrical stimulation (PES), may improve outcomes in chronic LBP. However, the optimal cerebral target for stimulation still remains controversial. This pilot trial aims to investigate whether active stimulation could promote additional gains to the PES results in LBP patients. Our secondary objective is to investigate whether the stimulation of primary motor cortex and dorsolateral prefrontal cortex results in distinct clinical effects for the patients involved. Methods: Sixty patients with chronic low back pain will be randomized into one of three tDCS groups associated with PES: motor primary cortex, dorsolateral prefrontal cortex and sham stimulation. Each group will receive transcranial direct current stimulation at an intensity of 2 mA for 30 minutes daily for 10 consecutive days. Patients will be assessed with a Brief Pain Inventory (BPI), Roland Morris Disability Questionnaire (RMDQ), Medical Outcomes Study 36-item Short - Form Health Survey (SF-36) and electromyography at baseline, endpoint (after 10 sessions) and 1-month follow up. Discussion: This study will help to clarify the additive effects of tDCS combined with peripheral electrical stimulation on pain relief, muscle function and improvement in quality of life. Additionally, we will provide data to identify optimal targets for management of chronic low back pain.

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Transcranial Direct Current Stimulation in the Management of Chronic Low Back Pain: A Systematic Review

10.5327/1516-3180.264 ◽

2021 ◽

Author(s):

Carolina Gabriela Divino Soares Gioia ◽

Caio de Almeida Lellis ◽

Caio Reis Borges ◽

Camila Puton ◽

Giovanna Garcia de Oliveira ◽

...

Keyword(s):

Systematic Review ◽

Clinical Trial ◽

Clinical Trials ◽

Low Back Pain ◽

Back Pain ◽

Direct Current ◽

Chronic Low Back Pain ◽

Transcranial Direct Current Stimulation ◽

Low Back ◽

Direct Current Stimulation

Introduction: Chronic Low Back Pain is a condition associated with changes in different brain regions, related to pain, posture and emotions. Objectives: Review the current literature about the efficiency and safety of Transcranial Direct Current Stimulation in the management of Chronic Low Back Pain. Design and setting: This is a systematic review of the literature conducted at the Pontifical Catholic University of Goiás. Methods: A systematic review of literature was conducted in the PubMed, BVS and Lilacs databases, with the following research strategy: “(Transcranial Direct Current Stimulation or TDCS) and (Low Back Pain)”. Randomized studies, clinical trials and case reports published in the last 10 years were selected. Results: A clinical trial showed that TDCS of the primary motor cortex (M1) for 20 minutes improved posture, balance and pain intensity of patients with CLBP. Also, a randomized clinical trial concluded that this technique, at 2-mA intensity, showed a significant reduction in CLBP. On the other hand, two randomized clinical trials showed that the results obtained did not support the application of the TDCS method for the treatment of CLBP, since the observed groups did not show considerable difference after stimulation. In addition, another double-blind controlled study also showed that TDCS over M1 did not influence the quality of patients’ CLBP. Conclusion: A conflict was noticed between the conclusions of the articles used to compose this review, that’s why more studies with scientific rigor are needed.

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