Different montages of transcranial direct current stimulation on postural stability in chronic low back pain patients: A randomized sham-controlled study

Article type: Research Article

Authors: Masoudi, Mona^a | Ehsani, Fatemeh^{a; *} | Hedayati, Rozita^a | Ramezani, Mona^a | Jaberzadeh, Shapour^b

Affiliations: [a] Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran | [b] Non-invasive Brain Stimulation and Neuroplasticity Laboratory, Department of Physiotherapy, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VIC, Australia

Correspondence: [*] Corresponding author: Fatemeh Ehsani, Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran. E-mails: f.ehsani@semums.ac.ir, fatemehehsani59@ yahoo.com. ORCID ID: 0000-0002-7528-973x.

Abstract: BACKGROUND: Impairment in both the motor and cognitive aspects of postural control is a critical issue in patients with chronic low back pain (CLBP) who experience high pain anxiety (HPA). OBJECTIVE: This study aimed to compare the effects of cathodal and anodal transcranial direct current stimulation (c-tDCS and a-tDCS) over the dorsolateral prefrontal cortex (DLPFC) on postural control during cognitive postural tasks in CLBP patients with HPA. METHODS: This study included 66 patients randomly assigned to three groups: DLPFC a-tDCS, DLPFC c-tDCS, and sham tDCS. All groups received 20 minutes of tDCS, but the stimulation was gradually turned off in the sham group. Postural stability indices were assessed using the Biodex Balance System. RESULTS: Both the a-tDCS and c-tDCS groups showed a significant reduction in most postural stability indices at static and dynamic levels after the interventions (immediately, 24 hours, and one-week follow-up) during the cognitive postural task (P< 0.01). Additionally, there was a significant improvement in postural balance in the a-tDCS and c-tDCS groups compared to the sham tDCS group (P< 0.01). Furthermore, the a-tDCS group showed significantly greater improvement than the c-tDCS group (P< 0.01). CONCLUSION: Based on the results, both a-tDCS and c-tDCS over the DLPFC had positive effects on postural control during cognitive postural tasks in CLBP patients with HPA.

Keywords: Chronic low back pain, pain-related anxiety, cathodal transcranial direct current stimulation, anodal transcranial direct current stimulation, dorsolateral prefrontal cortex, postural stability

DOI: 10.3233/BMR-230229

Journal: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1151-1161, 2024