Recent evidence suggests that chronic low back pain is associated with plastic changes in the brain that can be modified by neuromodulation strategies.
Chronic low back pain is a leading health issue that
leads to severe pain and disturbs brain functioning. Various therapeutic
modalities like direct current stimulation (tDCS) and peripheral electrical
stimulation (PES) proven to be very helpful in normalising brain functioning
and alleviating pain. This study enlightened that the tDCS in combination with
PES techniques can generate analgesic pain leading to pain alleviation.
Recent evidence suggests that chronic low back pain is
associated with plastic changes in the brain that can be modified by
neuromodulation strategies. This study investigated the efficacy of
transcranial direct current stimulation (tDCS) combined simultaneously with
peripheral electrical stimulation (PES) for pain relief, disability and global
perception in patients with chronic low back pain (CLBP).
Ninety-two patients with CLBP were randomized to receive
12 sessions on nonconsecutive days of anodal tDCS (primary motor cortex, M1),
100 Hz sensory PES (lumbar spine), tDCS + PES or sham tDCS + PES. Pain
intensity (11-point numerical rating scale), disability and global perception
were applied before treatment and four weeks, three months and six months
post-randomization.
A two points reduction was achieved only by the tDCS +
PES (mean reduction [MR] = −2.6, CI95% = −4.4 to −0.9) and PES alone (MR =
−2.2, CI95% = −3.9 to −0.4) compared with the sham group, but not of tDCS alone
(MR = −1.7, CI95% = −3.4 to −0.0). In addition to maintaining the analgesic
effect for up to three months, tDCS + PES had a higher proportion of
respondents in different cutoff points. The global perception was improved at four
weeks and maintained three months after treatment only with tDCS + PES. None of
the treatments improved disability and the affective aspect of pain
consistently with pain reduction.
The results suggest that tDCS + PES and PES alone are effective
in relieving CLBP in the short term. However, only tDCS + PES induced a
long-lasting analgesic effect. tDCS alone showed no clinically meaningful pain
relief.
Wiley Online Library
Treating low back pain with combined cerebral and peripheral electrical stimulation: A randomized, double-blind, factorial clinical trial
F. A. Hazime et al.
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