Transcranial Direct Current Stimulation for Affective Symptoms and Functioning in Chronic Low Back Pain: A Pilot Double-Blinded, Randomized, Placebo-Controlled Trial

Timothy Y Mariano; Frederick W Burgess; Marguerite Bowker; Jason Kirschner; Mascha Van't Wout-Frank; Richard N Jones; Christopher W Halladay; Michael Stein; Benjamin D Greenberg

doi:10.1093/pm/pny188

Transcranial Direct Current Stimulation for Affective Symptoms and Functioning in Chronic Low Back Pain: A Pilot Double-Blinded, Randomized, Placebo-Controlled Trial

Pain Med. 2019 Jun 1;20(6):1166-1177. doi: 10.1093/pm/pny188.

Authors

Timothy Y Mariano^{1

2}, Frederick W Burgess³, Marguerite Bowker³, Jason Kirschner^{1

3

4}, Mascha Van't Wout-Frank^{3

4}, Richard N Jones^{1

3

4}, Christopher W Halladay³, Michael Stein^{1

5}, Benjamin D Greenberg^{1

3

4}

Affiliations

¹ Butler Hospital, Providence, Rhode Island.
² Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
³ Center for Neurorestoration and Neurotechnology, Providence Veterans Affairs Medical Center, Providence, Rhode Island.
⁴ Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
⁵ Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA.

Abstract

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.

Keywords: CLBP; Chronic Low Back Pain; Dorsal Anterior Cingulate Cortex; Transcranial Direct Current Stimulation; dACC; tDCS.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Adult
Affective Symptoms / diagnosis*
Affective Symptoms / psychology
Affective Symptoms / therapy*
Double-Blind Method
Female
Follow-Up Studies
Humans
Low Back Pain / diagnosis*
Low Back Pain / psychology
Low Back Pain / therapy*
Male
Pain Management / methods*
Transcranial Direct Current Stimulation / methods*
Young Adult

Grants and funding

R25 MH101076/MH/NIMH NIH HHS/United States