Effects of transcranial direct-current stimulation combined with physical therapy in chronic low back pain treatments: A randomized controlled pilot study

Authors

  • Mai Loan Pham Thi Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
  • Wanida Donpunha Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
  • Saowanee Nakmareong Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
  • Paradee Auvichayapat Faculty of Medicine, Khon Kaen University, Khon Kaen Thailand
  • Kittisak Sawanyawisuth Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
  • Taweesak Janyacharoen Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen, Thailand

Keywords:

Chronic low back pain, tDCS, physical therapy, pain intensity, gait speed

Abstract

Background: Chronic low back pain (CLBP) affects 80.0% of the population and reduces their quality of life (QOL). Searching for its most effective treatment has being a challenge in the health-care system. Although studies using transcranial direct current stimulation (tDCS) plus physical therapy (PT) that aim to relieve pain, an optimal intervention method and clinical effectiveness evaluations related to CLBP patient aspects have not been completely investigated.

Objectives: The purpose of this study was to compare treatment effects between a combination of tDCS and PT (combined group) and PT alone (PT group) in pain intensity, gait speed, lumbar range of motion (LROM), QOL in CLBP patients. Besides, we examined the relationships between pain intensity and the remaining variables.

Methods: Twenty CLBP patients participated in this study, randomly divided into PT group and combined group following a 1:1 ratio. Pain intensity, gait speed, LROM, QOL were evaluated before (Pre) and after treatment (Post) as well as a follow-up after 1 week (W1), 2 weeks (W2), 3 weeks (W3), and 4 weeks (W4).

Results: The results showed a significant improvement in pain intensity, gait speed, LROM, QOL in 2 groups, but there were no statistically significant differences between groups for pain intensity, fast speed, lumbar bending the left (LBL), lumbar bending the right (LBR), and QOL. Furthermore, the combined group indicated a correlation: the larger the pain reduction, the larger the gait speed improvement.

Conclusion: A combination between tDCS and PT may be a potentially physiologic method to promote therapeutic efficacy and improve gait speed for CLBP patients.

Downloads

Download data is not yet available.

References

Institute for Clinical Systems Improvement. Adult acute and subacute low back pain: Health care guideline. 15th ed. Bloomington, MN: ICSI; 2012.

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. Man Ther 2011;16:15-20. https://doi.org/10.1016/j.math.2010.06.008

Strutton PH, Theodorou S, Catley M, McGregor AH, Davey NJ. Cortical excitability in patients with chronic low back pain. J Spinal Disord Tech 2005;18:420-4. https://doi.org/10.1097/01.bsd.0000169063.84628.fe

Ondrejkovicova A, Petrovics G, Svitkova K, Balogh V. Is non-pharmacological treatment an effective option for chronic low back pain? Neuro Endocrinol Lett 2017;38:169-72.

Yurdakul OV, Beydoğan E, Yılmaz Yalçınkaya E. Effects of physical therapy agents on pain, disability, quality of life, and lumbar paravertebral muscle stiffness via elastography in patients with chronic low back pain. Turk J Phys Med Rehabil 2019;65:30-9.

https://doi.org/10.5606/tftrd.2019.2373

Altınbilek T, Murat S. A comparison of application frequency of physical therapy modalities in patients with chronic mechanical low back pain. Turk J Phys Med Rehabil 2020;66:201-9. https://doi.org/10.5606/tftrd.2020.4192

Doğan ŞK, Tur BS, Kurtaiş Y, Atay MB. Comparison of three different approaches in the treatment of chronic low back pain. Clin Rheumatol 2008;27:873-81. https://doi.org/10.1007/s10067-007-0815-7

Schabrun SM, Jones E, Elgueta Cancino EL, Hodges PW. Targeting chronic recurrent low back pain from the top-down and the bottom-up: a combined transcranial direct current stimulation and peripheral electrical stimulation intervention. Brain Stimul 2014;7:451-9. https://doi.org/10.1016/j.brs.2014.01.058

Hazime FA, Baptista AF, de Freitas DG, Monteiro RL, Maretto RL, Hasue RH, et al. Treating low back pain with combined cerebral and peripheral electrical stimulation: A randomized, double-blind, factorial clinical trial. Eur J Pain 2017;21:1132-43.

https://doi.org/10.1002/ejp.1037

Straudi S, Buja S, Baroni A, Pavarelli C, Pranovi G, Fregni F, et al. The effects of transcranial direct current stimulation (tDCS) combined with group exercise treatment in subjects with chronic low back pain: a pilot randomized control trial. Clin Rehabil 2018;32:1348-56. https://doi.org/10.1177/0269215518777881

Soler MD, Kumru H, Pelayo R, Vidal J, Tormos JM, Fregni F, et al. Effectiveness of transcranial direct current stimulation and visual illusion on neuropathic pain in spinal cord injury. Brain 2010;133:2565-77.

https://doi.org/10.1093/brain/awq184

Mendonca ME, Simis M, Grecco LC, Battistella LR, Baptista AF, Fregni F. Transcranial direct current stimulation combined with aerobic exercise to optimize analgesic responses in fibromyalgia: A randomized placebo-controlled clinical trial. Front Hum Neurosci 2016;10:68. https://doi.org/10.3389/fnhum.2016.00068

Nitsche MA, Paulus W. Sustained excitability elevations induced by transcranial DC motor cortex stimulation in humans. Neurology 2001;57:1899-901. https://doi.org/10.1212/WNL.57.10.1899

Maarrawi J, Peyron R, Mertens P, Costes N, Magnin M, Sindou M, et al. Motor cortex stimulation for pain control induces changes in the endogenous opioid system. Neurology 2007;69:827-34. https://doi.org/10.1212/01.wnl.0000269783.86997.37

Schabrun SM, Burns E, Thapa T, Hodges P. The response of the primary motor cortex to neuromodulation is altered in chronic low back pain: A preliminary study. Pain Med 2018;19:1227-36. https://doi.org/10.1093/pm/pnx168

Pinto CB, Teixeira Costa B, Duarte D, Fregni F. Transcranial direct current stimulation as a therapeutic tool for chronic pain. J ECT 2018;34:e36-e50. https://doi.org/10.1097/YCT.0000000000000518

Jafarzadeh A, Ehsani F, Yosephi MH, Zoghi M, Jaberzadeh S. Concurrent postural training and M1 anodal transcranial direct current stimulation improve postural impairment in patients with chronic low back pain. J Clin Neurosci 2019;68:224-34.

https://doi.org/10.1016/j.jocn.2019.07.017

Luedtke K, Rushton A, Wright C, Jürgens T, Polzer A, Mueller G, et al. Effectiveness of transcranial direct current stimulation preceding cognitive behavioural management for chronic low back pain: sham controlled double blinded randomised controlled trial. BMJ 2015;350:h1640. https://doi.org/10.1136/bmj.h1640

Riberto M, Marcon Alfieri F, Monteiro de Benedetto Pacheco K, Dini Leite V, Nemoto Kaihami H, Fregni F, et al. Efficacy of transcranial direct current stimulation coupled with a multidisciplinary rehabilitation program for the treatment of fibromyalgia. Open Rheumatol J 2011;5:45-50. https://doi.org/10.2174/1874312901105010045

Hicks GE, Sions JM, Coyle PC, Pohlig RT. Altered spatiotemporal characteristics of gait in older adults with chronic low back pain. Gait Posture 2017;55:172-6. https://doi.org/10.1016/j.gaitpost.2017.04.027

Mok NW, Brauer SG, Hodges PW. Hip strategy for balance control in quiet standing is reduced in people with low back pain. Spine (Phila Pa 1976) 2004;29:E107-12. https://doi.org/10.1097/01.BRS.0000115134.97854.C9

Nadkarni NK, Nunley KA, Aizenstein H, Harris TB, Yaffe K, Satterfield S, et al. Association between cerebellar gray matter volumes, gait speed, and information-processing ability in older adults enrolled in the Health ABC study. J Gerontol A Biol Sci Med Sci 2014;69:996-1003. https://doi.org/10.1093/gerona/glt151

Morton SM, Bastian AJ. Cerebellar control of balance and locomotion. Neuroscientist 2004;10:247-59.

https://doi.org/10.1177/1073858404263517

Morton SM, Bastian AJ. Mechanisms of cerebellar gait ataxia. Cerebellum 2007; 6:79-86.

https://doi.org/10.1080/14734220601187741

Ugawa Y, Uesaka Y, Terao Y, Hanajima R, Kanazawa I. Magnetic stimulation over the cerebellum in humans. Ann Neurol 1995;37:703-13. https://doi.org/10.1002/ana.410370603

Daskalakis ZJ, Paradiso GO, Christensen BK, Fitzgerald PB, Gunraj C, Chen R. Exploring the connectivity between the cerebellum and motor cortex in humans. J Physiol 2004;557 557(Pt 2):689-700. https://doi.org/10.1113/jphysiol.2003.059808

Galea JM, Jayaram G, Ajagbe L, Celnik P. Modulation of cerebellar excitability by polarity-specific noninvasive direct current stimulation. J Neurosci 2009;29:9115-22. https://doi.org/10.1523/JNEUROSCI.2184-09.2009

Bonab M, Colak TK, Toktas ZO, Konya D. Assessment of spatiotemporal gait parameters in patients with lumbar disc herniation and patients with chronic mechanical low back pain. Turk Neurosurg 2020;30:277-84.

Allali G, Montembeault M, Brambati SM, Bherer L, Blumen HM, Launay CP, et al. Brain structure covariance associated with gait control in aging. J Gerontol A Biol Sci Med Sci 2019;74:705-13. https://doi.org/10.1093/gerona/gly123

DaSilva AF, Truong DQ, DosSantos MF, Toback RL, Datta A, Bikson M. State-of-art neuroanatomical target analysis of high-definition and conventional tDCS montages used for migraine and pain control. Front Neuroanat 2015;9:89.

https://doi.org/10.3389/fnana.2015.00089

Siebner HR, Lang N, Rizzo V, Nitsche MA, Paulus W, Lemon RN, et al. Preconditioning of low-frequency repetitive transcranial magnetic stimulation with transcranial direct current stimulation: evidence for homeostatic plasticity in the human motor cortex. J Neurosci 2004;24:3379-85. https://doi.org/10.1523/JNEUROSCI.5316-03.2004

Kuo MF, Unger M, Liebetanz D, Lang N, Tergau F, Paulus W, et al. Limited impact of homeostatic plasticity on motor learning in humans. Neuropsychologia 2008;46:2122-8. https://doi.org/10.1016/j.neuropsychologia.2008.02.023

Downloads

Published

2023-07-17

How to Cite

1.
Pham Thi ML, Donpunha W, Nakmareong S, Auvichayapat P, Sawanyawisuth K, Janyacharoen T. Effects of transcranial direct-current stimulation combined with physical therapy in chronic low back pain treatments: A randomized controlled pilot study. Chula Med J [Internet]. 2023 Jul. 17 [cited 2024 Oct. 8];66(2). Available from: https://he05.tci-thaijo.org/index.php/CMJ/article/view/72