No effect of transcranial direct current stimulation seen on non-specific chronic LBP

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: N/A
OE EXCLUSIVE
Dr. Luedtke discusses the effectiveness of transcranial direct current stimulation for chronic low back pain
Synopsis
135 patients with non-specific chronic low back pain (LBP) were randomized to undergo anodal transcranial direct current stimulation (tDCS) or sham tDCS, each with cognitive behavioural management (CBT). The purpose of this study was to examine the effects of tDCS and CBT in patients with non-specific chronic LBP, and provide follow-up at 4, 12, and 24 weeks treatment. The findings from Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-Industry funded
Sponsor: Deutsche Forschungsgemeinschaft DFG
Conflicts: Other
CONTENT IS LOCKED
Why was this study needed now?
The incidence of low back pain (LBP) in the general population is high. Most patients recover from the condition after 6 months, but others may suffer chronic pain. Previous research had shown that transcranial direct current stimulation is able to reduce chronic LBP, although the overall quality of evidence was low, and conclusive evidence from randomized controlled trials has been scarce. Multimodal cognitive behavioural therapy programs have been suggested to modify destructive thinking and behaviour in order to reduce LBP and disability. This study was designed to evaluate the effectiveness of transcranial direct current stimulation with cognitive behavioural management in patients with non-specific LBP.
What was the principal research question?
In patients with non-specific chronic low back pain, is transcranial direct current stimulation, in addition to cognitive behavioural management, effective in reducing pain and disability when compared to sham transcranial direct current stimulation?
Population: 135 patients (aged 18-65) with non-specific chronic low back pain persisting for more than 12 weeks. All patients required a minimum of 15mm on a 0-100 visual analogue scale for pain, or at least 8 points on the Oswestry Disability Index (ODI).
Intervention: Anodal group: Patients received 20 minutes of anodal transcranial direct current stimulation on the left motor cortex at 2 mA over five days. Following direct stimulation, all patients participated in a cognitive behavioural management program over 4 weeks (n=67; 48 completed; Mean age: 45 +/- 9 [Range:26-64]; 34M/33F)
Comparison: Sham group: Identical procedure was presented to sham group patients as in the anodal group, but the transcranial direct current stimulator switched off after 30 seconds without the awareness of the patients. Following sham stimulation, all patients participated in a cognitive behavioural management program over 4 weeks. (n=68; 42 completed; Mean age: 72 +/- 10 [Range: 27-62]; 38M/30F)
Outcomes: Primary outcome measures included the Oswestry disability index (ODI) and a visual analog scale (VAS) for pain. Secondary outcomes included the RAND 36-Item health survey, the Fear Avoidance Beliefs Questionnaire, Hospital Anxiety and Depression Score, and patient perceived satisfactory improvement.
Methods: RCT; Prospective; Double-blind; single-center
Time: Patients were assessed at baseline, 24 hours after the last transcranial direct current stimulation, and on the last day of cognitive behavioural management. Follow-up assessments were also made at 4, 12, and 24 weeks after the last day of cognitive behavioural management to observe post-treatment effects.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.