Transcranial Direct Current Stimulation of the Motor Cortex in the Treatment of Chronic Nonspecific Low Back Pain

O’Connell, Neil E; Cossar, John; Marston, Louise; Wand, Benedict M; Bunce, David; Souza, Lorraine H. De; Maskill, David; Sharp, Andrew; Moseley, G. Lorimer

doi:10.1097/ajp.0b013e318247ec09

Cited by 63 publications

(49 citation statements)

References 21 publications

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“…On the other hand, a recent study suggests that the sham tDCS procedure commonly used in tDCS research – including the present study – might not be truly blind to patient participants [23]. Thus, it remains possible that the beneficial effects of active tDCS relative to sham tDCS may be due, at least in part, to placebo effects.…”

Section: Discussionmentioning

confidence: 84%

“…Other research suggests the possibility of anodal tDCS for treatment phantom limb pain [21] and migraine headache [22]. However, research findings do not universally support the efficacy of tDCS for reducing chronic pain [23]. As a group, these findings provide preliminary support for the possibility that anodal tDCS applied over M1 may be effective for treating some – but not all – types of chronic pain.…”

Section: Introductionmentioning

confidence: 91%

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Pain Reduction in Myofascial Pain Syndrome by Anodal Transcranial Direct Current Stimulation Combined With Standard Treatment

Sakrajai

Janyacharoen

Jensen

et al. 2014

The Clinical Journal of Pain

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Background Myofascial pain syndrome (MPS) in the shoulder is among the most prevalent pain problems in the middle-aged population worldwide. Evidence suggests that peripheral and central sensitization may play an important role in the development and maintenance of shoulder MPS. Given previous research supporting the potential efficacy of anodal transcranial direct current stimulation (tDCS) for modulating pain-related brain activity in individuals with refractory central pain, we hypothesized that anodal tDCS when applied over the primary motor cortex (M1) combined with standard treatment will be more effective for reducing pain in patients with MPS than standard treatment alone. Method Study participants were randomized to receive either (1) standard treatment with 5-consecutive days of 1 mA anodal tDCS over M1 for 20 min or (2) standard treatment plus sham tDCS. Measures of pain intensity, shoulder passive range of motion, analgesic medication use, and self-reported physical functioning were administered before treatment and again at post-treatment and 1-, 2-, 3-and 4-week follow-up. Results Thirty-one patients with MPS were enrolled. Participants assigned to the active tDCS condition reported significantly more pre- to post-treatment reductions in pain intensity that were maintained at 1-week post-treatment, and significant improvement in shoulder adduction PROM at 1-week follow-up than participants assigned to the sham tDCS condition. Conclusion 5 consecutive days of anodal tDCS over M1 combined with standard treatment appears to reduce pain intensity, and may improve PROM, faster than standard treatment alone. Further tests of the efficacy and duration of effects of tDCS in the treatment of MPS are warranted.

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Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 91%

Pain Reduction in Myofascial Pain Syndrome by Anodal Transcranial Direct Current Stimulation Combined With Standard Treatment

Sakrajai

Janyacharoen

Jensen

et al. 2014

The Clinical Journal of Pain

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“…Previous studies have investigated the analgesic effect of tDCS in chronic pain conditions such as low back pain [15, 47], chronic pelvic pain [18], fibromyalgia [21, 48, 49] and neuropathic pain after spinal cord injury [50] with conflicting results. This study is the first to use tDCS in knee OA and to combine tDCS with strengthening exercise in any pain condition.…”

Section: Discussionmentioning

confidence: 99%

Addition of transcranial direct current stimulation to quadriceps strengthening exercise in knee osteoarthritis: A pilot randomised controlled trial

et al. 2017

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A randomised, assessor- and participant-blind, sham-controlled trial was conducted to assess the safety and feasibility of adding transcranial direct current stimulation (tDCS) to quadriceps strengthening exercise in knee osteoarthritis (OA), and provide data to inform a fully powered trial. Participants were randomised to receive active tDCS+exercise (AT+EX) or sham tDCS+exercise (ST+EX) twice weekly for 8 weeks whilst completing home exercises twice per week. Feasibility, safety, patient-perceived response, pain, function, pressure pain thresholds (PPTs) and conditioned pain modulation (CPM) were assessed before and after treatment. Fifty-seven people were screened for eligibility. Thirty (52%) entered randomisation and 25 (84%) completed the trial. One episode of headache in the AT+EX group was reported. Pain reduced in both groups following treatment (AT+EX: p<0.001, partial η2 = 0.55; ST+EX: p = 0.026, partial η2 = 0.18) but no between-group differences were observed (p = 0.18, partial η2 = 0.08). Function improved in the AT+EX (p = 0.01, partial η2 = 0.22), but not the ST+EX (p = 0.16, partial η2 = 0.08) group, between-group differences did not reach significance (p = 0.28, partial η2 = 0.052). AT+EX produced greater improvements in PPTs than ST+EX (p<0.05) (superolateral knee: partial η2 = 0.17; superior knee: partial η2 = 0.3; superomedial knee: partial η2 = 0.26). CPM only improved in the AT+EX group but no between-group difference was observed (p = 0.054, partial η2 = 0.158). This study provides the first feasibility and safety data for the addition of tDCS to quadriceps strengthening exercise in knee OA. Our data suggest AT+EX may improve pain, function and pain mechanisms beyond that of ST+EX, and provides support for progression to a fully powered randomised controlled trial.

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“…Several studies have shown that M1 stimulation improved pain management outcomes in patients with chronic pain, such as patients with fibromyalgia, 13,14 trigeminal neuralgia, 15 phantom pain, 16 chronic migraine, 17 low back pain 18 and myofascial pain syndrome. 19 Also, the M1 is a target that allows us to characterize pathophysiological consequences associated with chronic pain at the motor cortex by neurophysiological measurements made by transcranial magnetic stimulation (TMS).…”

Section: Introductionmentioning

confidence: 99%

Descending Control of Nociceptive Processing in Knee Osteoarthritis Is Associated With Intracortical Disinhibition

et al. 2016

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Based on the hypothesis that an imbalance in excitatory and inhibitory input is a central mechanism of knee osteoarthritis chronic pain (KOACP), this exploratory study had the following aims: to compare whether the function of the descending inhibitory pain pathway is associated with the state of inhibition in the corticospinal system indexed by the motor-evoked potential (MEP) and the cortical salient period (CSP) in patients with severe osteoarthritis (OA) and healthy controls; and to determine if there is correlation between the measures of intracortical inhibition (CSP, MEP) with changes on the numerical pain scale (NPS [0–10]) in KOACP during a conditioned pain modulation (CPM)-task considering the effect of self-reported function assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and analgesic use.In a cross-sectional study, we included females (n = 21), with disability by pain or stiffness due to KOACP and healthy controls (n = 10), aged 19 to 75 years. The motor cortex excitability parameters (MEP and CSP) were assessed using the transcranial magnetic stimulation. We assessed the pain and disability by the WOMAC, and change on NPS (0–10) during CPM-task.A Multivariate analysis of covariance revealed that the adjusted mean (SD) on the MEP amplitude was 13.53% higher in the OA than in healthy subjects (1.33 [0.49] vs 1.15 [0.13]), respectively (P = 0.16). The adjusted mean (SD) on the CSP observed in OA patients was 23.43% lower than in healthy subjects (54.54 [16.10] vs 70.94 [22.87]), respectively (P = 0.01). The function of the descending pain modulatory system assessed by change on NPS (0–10) during a CPM-task was negatively correlated with the cortical excitability parameter indexed by the CSP (P = 0.001). Also, the CSP was negatively correlated with the pain and disability assessed by the WOMAC index.These findings support the hypothesis that the change in cortical plasticity in KOACP is associated with less intracortical inhibition, as measured by the CSP. These results show that the neural change in the motor cortex in KOACP is associated with pain and disability levels, and also with decreased activation of the endogenous pain-modulating system by a CPM-task.

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Transcranial Direct Current Stimulation of the Motor Cortex in the Treatment of Chronic Nonspecific Low Back Pain

Abstract: These results do not provide evidence that tDCS is effective in the treatment of chronic back pain. The use of a small convenience sample limits the generalizability of these findings and precludes definitive conclusions on the efficacy of tDCS in chronic nonspecific low back pain.

Cited by 63 publications

References 21 publications

Pain Reduction in Myofascial Pain Syndrome by Anodal Transcranial Direct Current Stimulation Combined With Standard Treatment

Pain Reduction in Myofascial Pain Syndrome by Anodal Transcranial Direct Current Stimulation Combined With Standard Treatment

Addition of transcranial direct current stimulation to quadriceps strengthening exercise in knee osteoarthritis: A pilot randomised controlled trial

Descending Control of Nociceptive Processing in Knee Osteoarthritis Is Associated With Intracortical Disinhibition

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