Journal
PAIN MEDICINE
Volume 20, Issue 6, Pages 1166-1177Publisher
OXFORD UNIV PRESS
DOI: 10.1093/pm/pny188
Keywords
Transcranial Direct Current Stimulation; tDCS; Chronic Low Back Pain; CLBP; Dorsal Anterior Cingulate Cortex; dACC
Categories
Funding
- Butler Hospital
- National Institute of Mental Health [R25 MH101076]
- 2015 NARSAD Young Investigator Grant
- Brown Institute for Brain Science
- Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Rehabilitation Research and Development Service
- Center of Excellence for Neurorestoration and Neurotechnology at the Providence VA Medical Center
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Background and Objective. Chronic low back pain (CLBP) is highly prevalent, with a substantial psychosocial burden. Pain has both sensory and affective components. The latter component is a significant driver of disability and psychiatric comorbidity but is often inadequately treated. Previously we reported that noninvasive transcranial direct current stimulation (tDCS) may modulate pain-associated affective distress. Here we tested whether 10 daily tDCS sessions aimed to inhibit the left dorsal anterior cingulate cortex (dACC), a region strongly implicated in the affective component of pain, would produce selective reduction in pain-related symptoms. Methods. In this multisite, double-blinded, randomized placebo-controlled trial (RCT), 21 CLBP patients received 10 weekday sessions of 2-mA active tDCS or sham (20 minutes/session). A cathodal electrode was placed over FC1 (10-20 electroencephalography coordinates), and an identical anodal return electrode was placed over the contralateral mastoid. Participants rated pain intensity, acceptance, interference, disability, and anxiety, plus general anxiety and depression. Results. Regression analysis noted significantly less pain interference (P-0.002), pain disability (P-0.001), and depression symptoms (P -0.003) at six-week follow-up for active tDCS vs sham. Omnibus tests suggested that these improvements were not merely due to baseline (day 1) group differences. Conclusions. To our knowledge, this is the first double-blinded RCT of multiple tDCS sessions targeting the left dACC to modulate CLBP's affective symptoms. Results are encouraging, including several possible tDCS-associated improvements. Better-powered RCTs are needed to confirm these effects. Future studies should also consider different stimulation schedules, additional cortical targets, high-density multi-electrode tDCS arrays, and multimodal approaches.
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