Transcranial Direct Current Stimulation for Affective Symptoms and Functioning in Chronic Low Back Pain: A Pilot Double-Blinded, Randomized, Placebo-Controlled Trial.

Abstract

BACKGROUND AND OBJECTIVE:

Chronic low back pain (CLBP) is highly prevalent, with a substantial psychosocial burden. Pain has both sensory and affective components. The latter component is a significant driver of disability and psychiatric comorbidity but is often inadequately treated. Previously we reported that noninvasive transcranial direct current stimulation (tDCS) may modulate pain-associated affective distress. Here we tested whether 10 daily tDCS sessions aimed to inhibit the left dorsal anterior cingulate cortex (dACC), a region strongly implicated in the affective component of pain, would produce selective reduction in pain-related symptoms.

METHODS:

In this multisite, double-blinded, randomized placebo-controlled trial (RCT), 21 CLBP patients received 10 weekday sessions of 2-mA active tDCS or sham (20 minutes/session). A cathodal electrode was placed over FC1 (10-20 electroencephalography coordinates), and an identical anodal return electrode was placed over the contralateral mastoid. Participants rated pain intensity, acceptance, interference, disability, and anxiety, plus general anxiety and depression.

RESULTS:

Regression analysis noted significantly less pain interference (P =0.002), pain disability (P =0.001), and depression symptoms (P =0.003) at six-week follow-up for active tDCS vs sham. Omnibus tests suggested that these improvements were not merely due to baseline (day 1) group differences.

CONCLUSIONS:

To our knowledge, this is the first double-blinded RCT of multiple tDCS sessions targeting the left dACC to modulate CLBP's affective symptoms. Results are encouraging, including several possible tDCS-associated improvements. Better-powered RCTs are needed to confirm these effects. Future studies should also consider different stimulation schedules, additional cortical targets, high-density multi-electrode tDCS arrays, and multimodal approaches.

• Authors: Timothy Y Mariano, Frederick W Burgess, Marguerite Bowker, Jason Kirschner, Mascha Van't Wout-Frank, Richard N Jones, Christopher W Halladay, Michael Stein, Benjamin D Greenberg
• Journal: Pain medicine (Malden, Mass.) (Pain Med) Vol. 20 Issue 6 Pg. 1166-1177 (06 01 2019) ISSN: 1526-4637 [Electronic] England
• PMID: 30358864 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.)
• Copyright: © 2018 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: [email protected].

Topics

• Adult
• Affective Symptoms (diagnosis, psychology, therapy)
• Double-Blind Method
• Female
• Follow-Up Studies
• Humans
• Low Back Pain (diagnosis, psychology, therapy)
• Male
• Pain Management (methods)
• Transcranial Direct Current Stimulation (methods)
• Young Adult