title: Analgesic efficacy of cerebral and peripheral electrical stimulation in chronic nonspecific low back pain: a randomized, double-blind, factorial clinical trial.
abstract: BACKGROUND
  Chronic non-specific low back pain is a major socioeconomic public health issue worldwide and, despite the volume of research in the area, it is still a difficult-to-treat condition. The conservative analgesic therapy usually comprises a variety of pharmacological and non-pharmacological strategies, such as transcutaneous electrical nerve stimulation. The neuromatrix pain model and the new findings on the process of chronicity of pain point to a higher effectiveness of treatments that address central rather than peripheral structures. The transcranial direct current stimulation is a noninvasive technique of neuromodulation that has made recent advances in the treatment of chronic pain. The simultaneous combination of these two electrostimulation techniques (cerebral and peripheral) can provide an analgesic effect superior to isolated interventions. However, all the evidence on the analgesic efficacy of these techniques, alone or combined, is still fragmented. This is a protocol for a randomized clinical trial to investigate whether cerebral electrical stimulation combined with peripheral electrical stimulation is more effective in relieving pain than the isolated application of electrical stimulations in patients with chronic nonspecific low back pain.
  
  
  METHODS
  Ninety-two patients will be randomized into four groups to receive transcranial direct current stimulation (real/sham) + transcutaneous electrical nerve stimulation (real/sham) for 12 sessions over a period of four weeks. The primary clinical outcome (pain intensity) and the secondary ones (sensory and affective aspects of pain, physical functioning and global perceived effect) will be recorded before treatment, after four weeks, in Month 3 and in Month 6 after randomization. Confounding factors such as anxiety and depression, the patient's satisfaction with treatment and adverse effects will also be listed. Data will be collected by an examiner unaware of (blind to) the treatment allocation.
  
  
  CONCLUSIONS
  The results of this study may assist in clinical decision-making about the combined use of cerebral and peripheral electrical stimulation for pain relief in patients with chronic low back pain.
  
  
  BACKGROUND
  NCT01896453.
authors: Department of Physical Therapy, Universidade Federal do Piauí - UFPI, Avenida São Sebastião, 2819, CEP: 64202-020, Parnaíba, PI, Brasil. fuad@ufpi.edu.br.|Department of Physical Therapy, Speech-Language Pathology and Occupational Therapy, Doctoral Programs in Rehabilitation Sciences, Faculdade de Medicina da Universidade de São Paulo - USP, Rua Cipotânea, 51, Cidade Universitária, CEP: 05360-160, São Paulo, SP, Brasil. fuad@ufpi.edu.br.
authors: Fuad Ahmad
authors: FA
authors: Hazime
authors: Department of Physical Therapy, Irmandade Santa Casa de Misericórdia de São Paulo, Rua Dr Cesário Motta Jr, 112, CEP: 01221-020, São Paulo, SP, Brasil. diegogalace@yahoo.com.br.|Department of Physical Therapy, Universidade Paulista - UNIP, Rua Antonio de Macedo, 505, CEP: 03087-040, São Paulo, SP, Brasil. diegogalace@yahoo.com.br.
authors: Diego Galace
authors: DG
authors: de Freitas
authors: Department of Physical Therapy, Universidade Federal do Amapá - UFAP, Macapá, AP - Brasil, Rod. Juscelino Kubitschek Km 02, CEP: 68903-419, Macapá, AP, Brasil. renanlm@usp.br.|Department of Physical Therapy, Speech-Language Pathology and Occupational Therapy, Doctoral Programs in Rehabilitation Sciences, Faculdade de Medicina da Universidade de São Paulo - USP, Rua Cipotânea, 51, Cidade Universitária, CEP: 05360-160, São Paulo, SP, Brasil. renanlm@usp.br.
authors: Renan Lima
authors: RL
authors: Monteiro
authors: Department of Physical Therapy, Irmandade Santa Casa de Misericórdia de São Paulo, Rua Dr Cesário Motta Jr, 112, CEP: 01221-020, São Paulo, SP, Brasil. r.lasso@gmail.com.
authors: Rafaela Lasso
authors: RL
authors: Maretto
authors: Department of Physical Therapy, Irmandade Santa Casa de Misericórdia de São Paulo, Rua Dr Cesário Motta Jr, 112, CEP: 01221-020, São Paulo, SP, Brasil. dicangs@hotmail.com.
authors: Nilza Aparecida de Almeida
authors: NA
authors: Carvalho
authors: Department of Physical Therapy, Speech-Language Pathology and Occupational Therapy, Doctoral Programs in Rehabilitation Sciences, Faculdade de Medicina da Universidade de São Paulo - USP, Rua Cipotânea, 51, Cidade Universitária, CEP: 05360-160, São Paulo, SP, Brasil. renatahhv@usp.br.
authors: Renata Hydee
authors: RH
authors: Hasue
authors: Department of Physical Therapy, Speech-Language Pathology and Occupational Therapy, Doctoral Programs in Rehabilitation Sciences, Faculdade de Medicina da Universidade de São Paulo - USP, Rua Cipotânea, 51, Cidade Universitária, CEP: 05360-160, São Paulo, SP, Brasil. smaj@usp.br.
authors: Silvia Maria Amado
authors: SM
authors: João
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety; D059350:Chronic Pain / Q000523:psychology / Q000628:therapy*; D003863:Depression; D004311:Double-Blind Method; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006257:Head; D006801:Humans; D017116:Low Back Pain / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D058748:Pain Perception; D017060:Patient Satisfaction; D004561:Transcutaneous Electric Nerve Stimulation / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
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