The Effect of Noninvasive Brain Stimulation to Reduce Nonspecific Low Back Pain

Abstract

Objective: We conducted a systematic review/meta-analysis to evaluate noninvasive brain stimulation (NIBS) efficacy to alleviate pain and improve disability in low back pain (LBP). Materials and Methods:A systematic literature search was performed by a librarian in MEDLINE, Embase, EBM Reviews, CINAHL, and Web of Science databases (last search: January 14, 2021). Data were pooled by the number of sessions and follow-up periods. Independent reviewers performed screening, data extraction, and risk of bias. Pain reduction and disability were used as outcomes.Results: Twelve articles were included in the qualitative synthesis and 8 in the meta-analysis. A single session of NIBS reduced pain compared with sham (standardized mean difference: −0.47; P < 0.001; very low-quality evidence). Repeated sessions of NIBS did not impact pain at short-term (mean difference [MD]: −0.31; P = 0.23) or midterm (MD: −0.56; P = 0.33; moderate quality evidence). Combining NIBS with cointerventions did not influence pain (MD: −0.31; P = 0.30; moderate quality evidence). NIBS did not have a statistically significant impact on disability.Discussion: There is very low-quality evidence suggesting that a single NIBS session reduces LBP intensity. In contrast, there is moderate quality evidence that repeated NIBS sessions or combination with cointervention did not improve pain or disability. Thus, current results do not support NIBS use to treat chronic LBP. Considering that tDCS was tested in 8 of 12 studies with little success, studies focusing on different NIBS techniques or innovative parameters are required to determine their potential to improve pain and disability in chronic LBP.

High-definition transcranial infraslow pink noise stimulation for chronic low back pain: protocol for a pilot, safety and feasibility randomised placebo-controlled trial

“…To date, there are only a limited number of studies evaluating the TES interventions in people with CLBP 45 46. A recent meta-analysis demonstrates that there is moderate quality evidence suggesting that neither repeated sessions of non-invasive brain stimulation nor its combination with other treatments significantly improves pain or disability in people with CLBP 45.…”

“…To date, there are only a limited number of studies evaluating the TES interventions in people with CLBP 45 46. A recent meta-analysis demonstrates that there is moderate quality evidence suggesting that neither repeated sessions of non-invasive brain stimulation nor its combination with other treatments significantly improves pain or disability in people with CLBP 45. As most studies evaluating tDCS of single brain region demonstrated little success in improving pain and disability in people with CLBP, future trials focusing on different TES techniques, targeting multiple cortical areas, using various parameters are warranted and recommended.…”

“…However, the evidence for effect of TES for treatment of CLBP is limited (n=10 pilot studies,33–42 n=2 protocols43 44) and have demonstrated mixed results. Recent systematic reviews and meta-analyses suggests that there is very low-quality evidence that a single session of TES have short term effects for improving pain in people with CLBP 45 46. Previous TES studies targeted altering cortical electrical activity of a single superficial brain region33–36 38–42 (eg, Motor cortex or dorsolateral prefrontal cortex) using transcranial direct current stimulation (tDCS), except one study37 that targeted a deeper brain region (dACC).…”

“…Recent systematic reviews and meta-analyses suggests that there is very low-quality evidence that a single session of TES have short term effects for improving pain in people with CLBP. 45 46 Previous TES studies targeted altering cortical electrical activity of a single superficial brain region 33–36 38–42 (eg, Motor cortex or dorsolateral prefrontal cortex) using transcranial direct current stimulation (tDCS), except one study 37 that targeted a deeper brain region (dACC). None of the studies has simultaneously targeted multiple-brain regions (pgACC, dACC, SSC) responsible for the descending and ascending modulation of nociceptive sensory information.…”

Non-invasive Brain Stimulation for Chronic Pain: State of the Art and Future Directions

“…Therefore, brain network disturbance is considered one of the possible causes of CLBP. A recent systematic analysis (eight studies) revealed that, compared with sham stimulation, 1 session of tDCS treatment resulted in substantial pain relief ( Patricio et al, 2021 ). By contrast, multiple sessions of tDCS treatment did not improve short-term and medium-term pain.…”