Authors: Luedtke K et al., BMJ 2015 350:h1640
A study of transcranial stimulation preceding behavioral cognitive therapy does not support the effectiveness of this procedure for the treatment of low back pain.
Chronic low back pain is a frequent and costly problem for which few interventions are effective. Chronic low back pain is characterized by a number of structural, functional, and neurochemical changes in the brain; however, the impact and nature of brain changes have not been tested enough, and treatments have not been fully developed or tested. Brain stimulation techniques have been used in the management of various pain conditions, including low back pain. The precise mechanisms by which brain stimulation may alleviate pain are not clear. To evaluate the effectiveness of transcranial direct current stimulation, alone or in combination with cognitive behavioral therapy, in patients with chronic low back pain, researchers conducted a randomized trial. From 225 eligible patients, 135 with nonspecific low back pain lasting >12 weeks received 20 minutes daily of 2 mA anodal or sham stimulation over the left motor cortex for 5 days. Immediately after stimulation, cognitive behavioral management was done.
Brain stimulation was ineffective for the reduction of pain (difference between groups on visual analog scale, 1 mm; 99% confidence interval, −8.69 mm to 6.3 mm; P=0.68) and disability (difference between groups, 1 point; 99% CI, −1.73 to 1.98; P=0.86). Brain stimulation did not affect the outcome of cognitive behavioral therapy.
These results do not support the effectiveness of transcranial direct current brain stimulation for the treatment of low back pain or reduction of disability. This finding mirrors a recent Cochrane review of the efficacy of noninvasive brain stimulation methods for chronic pain, which did not show a significant beneficial effect of cranial electrotherapy stimulation on chronic pain.