Non-specific chronic low back pain has serious personal and socio-economic consequences. International guidelines recommend multimodal cognitive behavioural management (CBT). The effectiveness of CBT might be enhanced by directly targeting central nervous system pain processing. Transcranial direct current stimulation (tDCS) is a novel approach aiming to influence pain by altering cortical excitability. An evaluation of existing reviews indicated the need for an up-to-date review of clinical and experimental pain trials. A systematic review including 14 trials (published 2006-2012) evaluating tDCS for the reduction of clinical and experimental pain identified a low level of evidence for its effectiveness. Only 1 trial had a low risk of bias. A meta-analysis of trials on clinical pain identified a small pain reducing effect that just reached clinical importance. To investigate the effectiveness of tDCS alone and in combination with CBT, a double-blind RCT was conducted; preceded by a feasibility study confirming practicability of trial procedures and patient acceptability of tDCS. Results indicated that tDCS alone or in combination with CBT did not significantly influence pain or disability. An updated meta-analysis, including this trial’s results, lowered the pain reducing effect of tDCS below clinical importance, and increased the level of evidence for its effectiveness to "high".
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:607351 |
| Date | January 2014 |
| Creators | Luedtke, Kerstin |
| Publisher | University of Birmingham |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://etheses.bham.ac.uk//id/eprint/5248/ |
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