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Identifying and Engaging Neuronal Oscillations by Transcranial Alternating Current Stimulation in Patients With Chronic Low Back Pain: A Randomized, Crossover, Double-Blind, Sham-Controlled Pilot Study

  • Sangtae Ahn
    Affiliations
    Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599

    Carolina Center for Neurostimulation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599
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  • Julianna H. Prim
    Affiliations
    Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599

    Carolina Center for Neurostimulation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599

    Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599
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  • Morgan L. Alexander
    Affiliations
    Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599

    Carolina Center for Neurostimulation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599
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  • Karen L. McCulloch
    Affiliations
    Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599

    Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599
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  • Flavio Fröhlich
    Correspondence
    Address reprint requests to Flavio Fröhlich, XX, 115 Mason Farm Road, NRB 4109F, Chapel Hill, NC 27599.
    Affiliations
    Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599

    Carolina Center for Neurostimulation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599

    Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599

    Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599

    Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599

    Neuroscience Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599.
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Published:September 27, 2018DOI:https://doi.org/10.1016/j.jpain.2018.09.004

      Highlights

      • Target identification of alpha oscillations by electroencephalography in chronic low back pain.
      • Target engagement of alpha oscillations by 10 Hz transcranial alternating current stimulation.
      • Target validation of enhanced alpha oscillations linked to clinical improvement.

      Abstract

      Chronic pain is associated with maladaptive reorganization of the central nervous system. Recent studies have suggested that disorganization of large-scale electrical brain activity patterns, such as neuronal network oscillations in the thalamocortical system, plays a key role in the pathophysiology of chronic pain. Yet, little is known about whether and how such network pathologies can be targeted with noninvasive brain stimulation as a nonpharmacological treatment option. We hypothesized that alpha oscillations, a prominent thalamocortical activity pattern in the human brain, are impaired in chronic pain and can be modulated with transcranial alternating current stimulation (tACS). We performed a randomized, crossover, double-blind, sham-controlled study in patients with chronic low back pain (CLBP) to investigate how alpha oscillations relate to pain symptoms for target identification and whether tACS can engage this target and thereby induce pain relief. We used high-density electroencephalography to measure alpha oscillations and found that the oscillation strength in the somatosensory region at baseline before stimulation was negatively correlated with pain symptoms. Stimulation with alpha-tACS compared to sham (placebo) stimulation significantly enhanced alpha oscillations in the somatosensory region. The stimulation-induced increase of alpha oscillations in the somatosensory region was correlated with pain relief. Given these findings of successful target identification and engagement, we propose that modulating alpha oscillations with tACS may represent a target-specific, nonpharmacological treatment approach for CLBP. This trial has been registered in ClinicalTrials.gov (NCT03243084).

      Perspective

      This study suggests that a rational design of transcranial alternating current stimulation, which is target identification, engagement, and validation, could be a nonpharmacological treatment approach for patients with CLBP.

      Key words

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