Transcranial Direct Current Stimulation Combined With Exercise in Low Back Pain

The Effects of Transcranial Direct Current Stimulation Combined With Pilates Based Exercise in the Treatment of Patients With Chronic Low Back Pain

The purpose of this study is to evaluate the effects of transcranial direct current stimulation combined with Pilates based exercise on chronic low back pain. This is a randomized clinical trial composed of two arms.

Chronic low back pain may be associated with pathoanatomical, neurophysiological, physical, psychological and social factors. Treatments that relieve the symptoms of these patients are of great importance to improve the quality of life of these individuals. Thus, this study aims to evaluate the effects of transcranial direct current stimulation combined with Pilates based exercise on chronic low back pain. This is a randomized clinical trial that will be composed of men and women between 18 and 65 years of age, with a history of low back pain for more than 12 weeks and a minimum pain intensity equal to 3 cm on the numerical pain scale. The volunteers will be randomized into two distinct groups: stimulation + exercise group (EG - will perform a Pilates based exercise protocol combined with transcranial direct current stimulation) and sham stimulation + exercise group (SG - will perform the same exercise program combined with sham stimulation). The interventions, regardless of the group, will be carried out three times a week for four weeks. Participants will be submitted to three assessments: the first (T0) will be performed before the treatment protocols; the second (T1) will be performed after the four weeks of intervention; and the third (T2) will be a follow-up one month after the end of the treatment protocol. Pain sensation, functional performance, central sensitization, quality of life, pressure pain threshold, global impression of change, adverse events and medication use will be evaluated. For the statistical analysis, a mixed model ANOVA will be performed for the inter and intragroup comparison, with Tukey's post hoc, considering a significance level of 5%.

Transcranial Direct Current Stimulation, Low back pain, Exercise, Chronic pain, Combined modality therapy, Motor cortex

30-minute exercise program (based on Pilates method) combined with active transcranial direct current stimulation.

This arm will perform the same procedures of experimental group but the stimulator will be turned off after 30 seconds and the volunteers will not receive current for the rest of the session.

Exercise protocol + application of simulation of direct current stimulation for 30 minutes. The stimulator will be turned off after 30 seconds and the volunteers will not receive current for the rest of the session.

Functional performance associated with low back pain measured by Roland Morris Disability Questionnaire (24 itens)

Change from baseline in functional performance at four weeks after intervention and 1 month of follow-up

Change from baseline in pressure pain threshold at four weeks after intervention and 1 month of follow-up

Change from baseline in quality of life questionnaires at four weeks after intervention and 1 month of follow-up

Patient global impression of change measured by a scale with seven points, where 1 is equal to no change or worse and 7 is much better.

Change from baseline in Patient global impression of change at each intervention day and at four weeks of intervention and 1 month of follow-up.

Evaluation of Central Sensitization using Central Sensitization Inventory (CSI).The questionnaire is divided into two parts, the first with a score from 0 to 100 measures 25 somatic and emotional symptoms, while the second part relates to specific previous diagnoses.

Change from baseline of central sensitization at four weeks after intervention and 1 month of follow-up.

Inclusion Criteria: Men and women with chronic nonspecific low back pain (for more than 12 weeks) and minimum pain intensity of 3 on numerical pain rating scale. Exclusion Criteria: diagnosis of fracture and spine pathologies, fibromyalgia, spine surgery in the last year; low cognitive level assessed by the Mini Mental State Examination; presence of central neurological diseases (such as Parkinson's and stroke) or psychiatric (such as depression or schizophrenia); history of epileptic illness; seizure history; brain implants; pacemaker; pregnancy.