Effect of Anodal Transcranial Direct Current Stimulation Combined with Exercise in Adults with Chronic Non-specific Low Back Pain: A Randomized Controlled Trial

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.

Download Full-text

T187. Transcranial Direct Current Stimulation (tDCS) for the Affective Symptoms of Chronic Low Back Pain (CLBP): A Double-Blinded, Randomized, Placebo-Controlled Trial

Biological Psychiatry ◽

10.1016/j.biopsych.2018.02.524 ◽

2018 ◽

Vol 83 (9) ◽

pp. S200-S201

Author(s):

Timothy Mariano ◽

Frederick 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

Download Full-text

Transcranial Direct Current Stimulation Combined With Therapeutic Exercise in Chronic Low Back Pain: Protocol of a Randomized Controlled Trial

Physical Therapy ◽

10.1093/ptj/pzaa105 ◽

2020 ◽

Vol 100 (9) ◽

pp. 1595-1602

Author(s):

Polyanna Gomes Lacerda Cavalcante ◽

Abrahão Fontes Baptista ◽

Vinícius Saura Cardoso ◽

Marcelo de Carvalho Filgueiras ◽

Renata Hydee Hasue ◽

...

Keyword(s):

Clinical Trial ◽

Low Back Pain ◽

Back Pain ◽

Direct Current ◽

Transcranial Direct Current Stimulation ◽

Low Back ◽

Therapeutic Exercise ◽

Direct Current Stimulation ◽

Randomized Controlled ◽

Clinical Benefits

Abstract Objective Although some studies have shown the clinical benefits of therapeutic exercise in chronic nonspecific low back pain, the effect sizes are generally small to moderate and recurrence rates are high. Transcranial direct current stimulation (tDCS) has been used to modulate pain-processing systems and motor outputs and has the potential to optimize the clinical benefits of therapeutic exercise. However, evidence for this combination is still lacking. The purpose of this protocol for a randomized clinical trial is to investigate whether the combination of tDCS and therapeutic exercise is more effective in relieving pain than therapeutic exercise alone. Methods This 2-arm, randomized controlled clinical trial will take place at the Federal University of Piauí, Brazil. Sixty patients will be randomized into 2 groups to receive tDCS (real/sham) + exercise therapies for 12 sessions over a period of 4 weeks. Pain intensity, sensory and affective aspects of pain, physical functioning, kinesiophobia, and global perceived effect will be recorded before treatment and at 4 weeks, 3 months, and 6 months after randomization. Data will be collected by an examiner unaware of (blind to) the treatment allocation. Impact This trial can potentially provide important information and assist in clinical decision-making on the combined use of tDCS to optimize the clinical benefits of therapeutic exercise in patients with chronic nonspecific low back pain.

Download Full-text

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 ◽

10.1136/bmjopen-2016-013080 ◽

2017 ◽

Vol 7 (8) ◽

pp. e013080 ◽

Cited By ~ 4

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

Download Full-text