The effect of transcranial direct current stimulation plus pain neuroscience education in patients with chronic low back pain and high pain catastrophizing – a pilot randomized controlled trial



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The primary purpose of this study was to assess the feasibility of a large double-blinded, randomized controlled trial (RCT), investigating the effects of combined active tDCS plus PNE (tDCS + PNE) to those of sham tDCS + PNE in patients with chronic low back pain (CLBP) and high pain catastrophizing. The secondary purpose was to examine the effect sizes between the two interventions and the effect sizes before and after each intervention in patients with CLBP and high pain catastrophizing. Twenty participants, 10 in each group, with CLBP and high pain catastrophizing were recruited and randomly allocated into the active tDCS + PNE or sham tDCS + PNE groups. All participants received five sessions of their assigned interventions over a 2 week period. Outcomes measures were assessed at baseline and following completion of the study, including the Numeric Pain Rating Scale (NPRS), Pain Catastrophizing Scale (PCS), Tampa Scale of Kinesiophobia (TSK), pressure pain thresholds (PPTs), Stroop Color and Word Test (SCWT), and Comprehensive Trailing Making Test – Second Edition (CTMT2). The study was determined to be feasible if (1) the 2-week attrition rate is less than 20%, (2) no adverse responses are reported, (3) at least 75% of patients complete follow-up assessment data, and (4) the time required by study personnel falls under 20% of the principal investigator’s (PI’s) full-time faculty workload. Effect sizes were calculated within each group and between the two groups. All participants completed the required intervention sessions and follow-up assessment. No adverse responses were reported, and 18.8% of the PI’s workload was required to complete the study. The active tDCS + PNE group demonstrated greater effect sizes in all outcome measures except the CTMT2 – Set Shifting test. The between-group effect sizes favored the active tDCS + PNE group with effect sizes ranging from 0.11–1.24. The results of this study suggest an RCT comparing the effects of active tDCS + PNE versus sham tDCS + PNE in patients with CLBP and high pain catastrophizing is feasible. In addition, active tDCS + PNE appeared to produce larger effect sizes than sham tDCS + PNE.



physical therapy, brain stimulation