title: Targeting chronic recurrent low back pain from the top-down and the bottom-up: a combined transcranial direct current stimulation and peripheral electrical stimulation intervention.
abstract: BACKGROUND
  Mechanisms such as neural sensitization and maladaptive cortical organization provide novel targets for therapy in chronic recurrent low back pain (CLBP).
  
  
  OBJECTIVE
  We investigated the effect of a transcranial direct current stimulation (tDCS) and peripheral electrical stimulation (PES) treatment on pain, cortical organization, sensitization and sensory function in CLBP.
  
  
  METHODS
  Using a placebo-controlled crossover design, 16 individuals received four treatments in separate sessions: (i) anodal tDCS/PES; (ii) anodal tDCS/sham PES; (iii) sham tDCS/PES; or (iv) sham tDCS/sham PES. Pain was assessed at baseline, immediately following, and at 1 and 3 days after treatment. Motor cortical organization, sensitization and sensory function were measured before and immediately after treatment.
  
  
  RESULTS
  Combined tDCS/PES reduced pain and sensitization, normalized motor cortical organization and improved sensory function. The reduction in pain was greater in individuals with more pronounced sensitization. Applied alone, tDCS or PES also reduced pain. However, with the exception of improved sensory function and reduced map volume following PES, clinical and neurophysiological outcomes were unaltered by tDCS or PES applied separately. No changes were observed following sham treatment.
  
  
  CONCLUSIONS
  Our data suggest a combined tDCS/PES intervention more effectively improves CLBP symptoms and mechanisms of cortical organization and sensitization, than either intervention applied alone or a sham control.
authors.affiliation: The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitations Sciences, St Lucia, Brisbane, Queensland 4072, Australia. Electronic address: s.schabrun@uq.edu.au.
authors.forename: Siobhan M
authors.initials: SM
authors.lastname: Schabrun
authors.affiliation: The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitations Sciences, St Lucia, Brisbane, Queensland 4072, Australia.
authors.forename: Emma
authors.initials: E
authors.lastname: Jones
authors.affiliation: The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitations Sciences, St Lucia, Brisbane, Queensland 4072, Australia.
authors.forename: Edith L
authors.initials: EL
authors.lastname: Elgueta Cancino
authors.affiliation: The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitations Sciences, St Lucia, Brisbane, Queensland 4072, Australia.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Hodges
mesh_terms: D000328:Adult; D018592:Cross-Over Studies; D004558:Electric Stimulation / Q000379:methods*; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D015233:Models, Statistical; D009044:Motor Cortex / Q000502:physiology; D065908:Transcranial Direct Current Stimulation / Q000379:methods*; D016896:Treatment Outcome
keywords: Chronic low back pain; Peripheral electrical stimulation; Transcranial direct current stimulation; Treatment