This exploratory study aimed to test the proof of principle that active anodal transcranial direct current stimulation (tDCS) applied to the motor cortex reduces pain significantly more than sham stimulation in a group of participants with chronic non-specific low back pain

Bunce, David

Cossar, John

De Souza, Lorraine H

Marston, Louise

Maskill, David W

Moseley, G Lorimer

O\u27Connell, Neil E

Sharp, Andrew

Wand, Benedict M

ResearchOnline@ND

University of Notre Dame AustraliaResearchOnline@NDPhysiotherapy Conference Papers School of Physiotherapy2011Transcranial direct current stimulation of the motor cortex in the treatment ofchronic non-specific low back pain. A randomised, double-blind exploratory studyNeil E. O'ConnellJohn CossarLouise MarstonBenedict M. WandUniversity of Notre Dame Australia, Benedict.Wand@nd.edu.auDavid BunceSee next page for additional authorsFollow this and additional works at: http://researchonline.nd.edu.au/physiotherapy_conferencePart of the Physical Therapy Commons, and the Physiotherapy CommonsThis other was originally published as:O'Connell, N. E., Cossar, J., Marston, L., Wand, B. M., Bunce, D., De Souza, L. H., Maskill, D. W., Sharp, A., & Moseley, G. (2011).Transcranial direct current stimulation of the motor cortex in the treatment of chronic non-specific low back pain. A randomised,double-blind exploratory study. World Physical Therapy 2011.This other is posted on ResearchOnline@ND athttp://researchonline.nd.edu.au/physiotherapy_conference/3. For moreinformation, please contact researchonline@nd.edu.au.AuthorsNeil E. O'Connell, John Cossar, Louise Marston, Benedict M. Wand, David Bunce, Lorraine H. De Souza,David W. Maskill, Andrew Sharp, and G Lorimer MoseleyThis other is available at ResearchOnline@ND: http://researchonline.nd.edu.au/physiotherapy_conference/3Title: Transcranial direct current stimulation of the motor cortex in the treatment of chronic non-specific low back pain. A randomised, double-blind exploratory study.  Authors:  Neil E O’Connell1 John Cossar1 Louise Marston2 Benedict M Wand3 David Bunce4 Lorraine H De Souza1 David W Maskill1 Andrew Sharp5 G Lorimer Moseley6  1. Centre for Research in Rehabilitation, School of Health Sciences and Social Care, Brunel University, Uxbridge, UK 2. Research Department of Primary Care & Population Health, Division of Population Health, Faculty of Biomedical Sciences, University College London, London, UK 3. School of Health Sciences, University of Notre Dame, Fremantle, W Australia 4. Centre for Cognition and Neuroimaging, Brunel University, London, UK 5. Physiotherapy Department , Hillingdon Hospitals NHS Trust, Middlesex, UK 6. Neuroscience Research Australia (NeuRA) , Sydney, Australia  Number of text pages (including tables and figures):  Corresponding Author:   Neil O’Connell Address: School of Health Sciences and Social Care, Brunel University, Kingston Lane, Uxbridge, UB8 3PH Tel: +44 1895 268814 Fax: +44 1895 269853 Email: neil.oconnell@brunel.ac.uk      Abstract  Purpose  This exploratory study aimed to test the proof of principle that active anodal transcranial direct current stimulation (tDCS) applied to the motor cortex reduces pain significantly more than sham stimulation in a group of participants with chronic non-specific low back pain.  Relevance  Evidence points to alterations in brain structure and function and abnormalities in sensory processing in people with chronic low back pain [1].  A number of clinical studies have indicated that tDCS may be an effective treatment for chronic pain [2-6]. A recent Cochrane review found insufficient evidence from which to draw strong conclusions but some evidence that tDCS applied to the motor cortex may have analgesic effects [7].  Participants A sample of 8 participants with chronic non-specific low back pain was recruited. The mean age was 45 years (SD 10), 7 of the 8 participants were female.  Methods  The study utilised a within-subjects sham-controlled, interrupted time series design with randomised multiple baselines. Following 3 days of baseline measures participants entered a 15 day experimental period (Mondays to Fridays) for 3 consecutive weeks. During this period each participant received sham stimulation daily until a randomly allocated day when active stimulation was commenced. Active stimulation was then given daily for the remaining days of the experimental period. The primary outcomes were average pain intensity and unpleasantness in the last 24 hours measured using a visual analogue scale (VAS). Secondary outcomes included self reported disability, depression and anxiety, a battery of cognitive tests to monitor for unwanted effects of stimulation and participants perception of whether they received active or sham.  Analysis  Data were analysed using generalised estimating equations modelling.  Results  All participants completed the study. No significant effect was seen in the primary outcomes between active and sham stimulation (average pain intensity p=0.821, unpleasantness p=0.937) or across any other clinical variables. There was some evidence that some participants may have been able to distinguish between the active and sham conditions (p=0.035).  Conclusions  The results of this exploratory do not suggest that tDCS is effective in reducing chronic low back pain. There is some preliminary evidence that the sham controls regularly employed in clinical trials of tDCS may not be optimal in terms of participant blinding.   Implications  This is the first study to investigate this treatment modality on CLBP and the results are not consistent with existing studies of tDCS in chronic pain conditions. Rigorous examination of the viability of sham controls commonly used in tDCS research is necessary.  Keywords transcranial direct current stimulation (tDCS); chronic non specific low back pain; sham.  Funding Acknowledgements  This study was supported by research grants from the charities BackCare and The Rosetrees Trust.  Ethics Approval  This study had full approval from the Kings College Hospital NHS Research Ethics Service, London, UK  References  1.  Wand BM, Parkitny L, O'Connell NE, Luomajoki H, McAuley JH, Thacker M, et al. Cortical changes in chronic low back pain: Current state of the art and implications for clinical practice. Manual therapy 2010; 6-11. 2.  Fenton BW, Palmieri Pa, Boggio P, Fanning J, Fregni F. A preliminary study of transcranial direct current stimulation for the treatment of refractory chronic pelvic pain. Brain Stimulation 2009; 2 (2): 103-107. 3.  Boggio PS, Amancio EJ, Correa CF, Cecilio S, Valasek C, Bajwa Z, et al. Transcranial DC stimulation coupled with TENS for the treatment of chronic pain: a preliminary study. The Clinical journal of pain 2009; 25 (8): 691-5. 4.  Fregni F, Boggio PS, Lima MC, Ferreira MJ, Wagner T, Rigonatti SP, et al. A sham-controlled, phase II trial of transcranial direct current stimulation for the treatment of central pain in traumatic spinal cord injury. Pain 2006; 122 (1-2): 197-209. 5.  Fregni F, Gimenes R, Valle AC, Ferreira MJ, Rocha RR, Natalle L, et al. A randomized, sham-controlled, proof of principle study of transcranial direct current stimulation for the treatment of pain in fibromyalgia. Arthritis and rheumatism 2006; 54 (12): 3988-98. 6.  Mori F, Codecà C, Kusayanagi H, Monteleone F, Buttari F, Fiore S, et al. Effects of anodal transcranial direct current stimulation on chronic neuropathic pain in patients with multiple sclerosis. The journal of pain : official journal of the American Pain Society 2010; 11 (5): 436-42.   7. O’Connell NE, Wand BM, Marston L ,Spencer S, DeSouza LH. Non-invasive brain stimulation for chronic pain in adults Cochrane Database of Systematic Reviews 2010; 9: CD008209   

Transcranial direct current stimulation of the motor cortex in the treatment of chronic non-specific low back pain. A randomised, double-blind exploratory study

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Transcranial direct current stimulation of the motor cortex in the treatment of chronic non-specific low back pain. A randomised, double-blind exploratory study

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