Effectiveness of transcranial direct current stimulation preceding cognitive behavioural management for chronic low back pain: sham controlled double blinded randomised controlled trial

Abstract

ObjeCtiveTo evaluate the effectiveness of transcranial direct current stimulation alone and in combination with cognitive behavioural management in patients with non-specific chronic low back pain.Design Double blind parallel group randomised controlled trial with six months' follow-up conducted May 2011-March 2013. Participants, physiotherapists, assessors, and analyses were blinded to group allocation.setting Interdisciplinary chronic pain centre.PartiCiPants 135 participants with non-specific chronic low back pain >12 weeks were recruited from 225 patients assessed for eligibility.interventiOn Participants were randomised to receive anodal (20 minutes to motor cortex at 2 mA) or sham transcranial direct current stimulation (identical electrode position, stimulator switched off after 30 seconds) for five consecutive days immediately before cognitive behavioural management (four week multidisciplinary programme of 80 hours). Main OutCOMes MeasuresTwo primary outcome measures of pain intensity (0-100 visual analogue scale) and disability (Oswestry disability index) were evaluated at two primary endpoints after stimulation and after cognitive behavioural management.

Delayed pain decrease following M1 tDCS in spinal cord injury: A randomized controlled clinical trial

“…In addition, the limited number of [19][20][21][22][23][24][25][26] sessions and small sample size, may not have been sufficient to observe significant effects at follow-up. The second study, on low back pain, even though the sample size was large (n = 135), did not show significant differences between sham and active tDCS [58]. However, low back pain is not a neuropathic pain and therefore the results cannot be directly translated to our findings.…”

Overlapping Chronic Pain Conditions: Implications for Diagnosis and Classification

“…Indeed, clinical trials for pain treatments typically target a specific pain condition, and the presence of other pain conditions is often an exclusion criterion. 67, 94 Thus, individuals with COPCs are significantly under-represented in clinical trials, resulting in a dearth of information regarding safe and effective therapies for patients with these common conditions.…”

Revisiting the Corticomotor Plasticity in Low Back Pain: Challenges and Perspectives

“…For example, one study showed that one session of rTMS over M1 improved CLBP intensity and the cold/heat pain threshold [ 118 ], but no study has ever tested longer-lasting after-effects following multiple sessions of rTMS [ 116 ]. In addition, two recent randomized double-blind designed studies reported that multiple sessions of tDCS over M1 did not improve CLBP [ 119 , 120 ], and one experimental study did not report immediate impact on pain threshold [ 121 ]. Thus, due to scarce data published on that topic, there is no clear evidence that central stimulation impacts pain or disability in CLBP.…”