Transcranial direct current stimulation (tDCS) of the left dorsal anterior cingulate cortex (dACC) may be associated with improvements in pain-related function, distress, and depression in patients with chronic low back pain, according to a study published in Pain Medicine.

A total of 21 patients age >18 with chronic low back pain and on stable medications for ≥1 month treated at the Providence Veterans Affairs Medical Center and Butler Hospital in Rhode Island were enrolled in the study. Study participants were randomly assigned to receive 10 weekday 2-mA active tDCS sessions (n=10) or a sham intervention (n=11), with each session lasting approximately 20 minutes. During each active tDCS session, physicians placed a cathodal electrode over FC1 and an anodal return electrode over the contralateral mastoid.

Researchers surveyed participants on pain acceptance (using the Chronic Pain Acceptance Questionnaire [CPAQ-8]), pain-related anxiety (with the Pain Anxiety Symptoms Scale [PASS-20]), disability (using the Roland Morris Disability Questionnaire [RMDQ]), pain interference (with the 18-item West Haven-Yale Multidimensional Pain Inventory’s General Activity Subscale [WHY-MPI-C]), pain intensity (with the 11-item Defense and Veterans Pain Rating Scale [DVPRS]), and general anxiety and depression (using the 9-item Patient Health Questionnaire [PHQ-9]).

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Pain intensity was not found to differ between active treatment and sham tDCS at days 1, 5, and 10 or at the 6-week follow-up (P >.58 for all). Study participants treated with active tDCS vs sham control reported lower pain interference (P =.002), lower pain disability (P =.001), and reduced depression (P =.003) at 6 weeks.

Limitations of the analysis include its short follow-up and the small number of patients in the final cohort.

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 “Future studies…should consider additional cortical targets, high-density multi-electrode arrays for better spatial resolution, and neuroimaging (instead of the electrode field modeling done in our study) to demonstrate engagement of desired cortical targets,” noted the study authors.

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Mariano TY, Burgess FW, Bowker M, et al. Transcranial direct current stimulation for affective symptoms and functioning in chronic low back pain: A pilot double-blinded, randomized, placebo-controlled trial [published online October 24, 2018]. Pain Med. doi:10.1093/pm/pny188