Journal
JOURNAL OF CLINICAL MEDICINE
Volume 10, Issue 4, Pages -Publisher
MDPI
DOI: 10.3390/jcm10040889
Keywords
high-definition transcranial direct current stimulation; conditioned pain modulation; low back pain; affect induction; distraction
Categories
Funding
- Danish National Research Foundation [DNRF121]
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Chronic low back pain is often associated with affective disturbance and dysfunctional pain mechanisms. A pilot trial using high-definition transcranial direct current stimulation (HD-tDCS) to the medial prefrontal cortex did not significantly alter the valence and arousal shifts due to affective manipulations, nor did it change the magnitude of conditioned pain modulation (CPM) across various trials. Further research is needed to determine the potential of HD-tDCS in enhancing attentional and affective effects on pain modulation.
Chronic low back pain (CLBP) is often without clear underlying pathology. Affective disturbance and dysfunctional pain mechanisms, commonly observed in populations with CLBP, have, therefore, been suggested as potential contributors to CLBP development and maintenance. However, little consensus exists on how these features interact and if they can be targeted using non-invasive brain stimulation. In this pilot trial, 12 participants completed two phases (Active or Sham) of high-definition transcranial direct current stimulation (HD-tDCS) to the medial prefrontal cortex, applied for 20 min on three consecutive days. Clinical pain ratings, questionnaires, and sensitivity to painful cuff pressure were completed at baseline, then 4 trials of conditioned pain modulation (CPM; alone, with distraction using a Flanker task, with positive affect induction, and with negative affect induction using an image slideshow) were performed prior to HD-tDCS on Day 1 and Day 4 (24 h post-HD-tDCS). At baseline, attentional and affective manipulations were effective in inducing the desired state (p < 0.001) but did not significantly change the magnitude of CPM-effect. Active HD-tDCS was unable to significantly alter the magnitude of the shift in valence and arousal due to affective manipulations, nor did it alter the magnitude of CPM under any basal, attentional, or affective manipulation trial significantly on Day 4 compared to sham. The CPM-effect was greater across all manipulations on Day 1 than Day 4 (p < 0.02) but also showed poor reliability across days. Future work is needed to expand upon these findings and better understand how and if HD-tDCS can be used to enhance attentional and affective effects on pain modulation.
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