Abstract
Chronic low back pain (CLBP) is highly disabling, but often without identifiable source.
Focus has been on impaired anti-nociceptive mechanisms contributing to pain maintenance,
though methods of targeting this impairment remain limited. This randomised-controlled
cross-over pilot trial used active versus sham medial prefrontal cortex (mPFC) high-definition
transcranial direct current stimulation (HD-tDCS) for 3-consecutive days to improve
descending pain inhibitory function. Twelve CLBP patients were included with an average
visual analogue scale (VAS) pain intensity of 3.0 ± 1.5 and pain duration of 5.3 ±
2.6 years. Pressure pain thresholds (PPTs), conditioned pain modulation (CPM), and
temporal summation of pain (TSP) assessed by cuff algometry, as well as pain symptomatology
(intensity, unpleasantness, quality, disability) and related psychological features
(pain catastrophizing, anxiety, affect), were assessed on Day1 before 3 consecutive
days of HD-tDCS sessions (each 20 minutes), at 24-hours (Day 4) and 2-weeks (Day 21)
following final HD-tDCS. Blinding was successful. No significant differences in psychophysical
(PPT, CPM, TSP), symptomatology or psychological outcomes were observed between active
and sham HD-tDCS on Day4 and Day21. CPM-effects at Day 1 negatively correlated with
change in CPM-effect at Day4 following active HD-tDCS (P = .002). Lack of efficacy was attributed to several factors, not least that patients
did not display impaired CPM at baseline.
Trial registration
: ClinicalTrials.gov (NCT03864822).
Perspective
Medial prefrontal HD-tDCS did not alter pain, psychological nor psychophysical outcomes,
though correlational analysis suggested response may depend on baseline pain inhibitory
efficacy, with best potential effects in patients with severe impairments in descending
pain inhibitory mechanisms. Future work should focus on appropriate patient selection
and optimising stimulation targeting.
Key words
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Article info
Publication history
Published online: March 03, 2021
Accepted:
February 19,
2021
Received in revised form:
February 9,
2021
Received:
October 14,
2020
Footnotes
Center for Neuroplasticity and Pain (CNAP) is supported by the Danish National Research Foundation (DNRF121). Nocitech is partly owned by Aalborg University.
The authors have no conflicts of interest to declare.
Trial registration: ClinicalTrials.gov (NCT03864822).
Identification
Copyright
© 2021 by United States Association for the Study of Pain, Inc.
