Neurophysiological Response to Neuromodulation is modified in Chronic Low Back Pain

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Neurophysiological Response to Neuromodulation is modified in Chronic Low Back Pain
Key Take-Away: 

Neuromodulation refers to a process in which a given neuron regulates the diverse population of neurons by use of one or more chemicals. This research has focused on determining the neurophysiological role of neuromodulation protocols in low back pain due to lack of evidence in previous studies

Neuromodulation is rapidly explored for low back pain (LBP) treatment. But, the neurophysiological outcomes of neuromodulatory techniques (anodal transcranial direct current stimulation [tDCS] and peripheral electrical stimulation [PES]) have not been studied in low back pain patients.

ABSTRACT: 
Background: 

Neuromodulation is rapidly explored for low back pain (LBP) treatment. But, the neurophysiological outcomes of neuromodulatory techniques (anodal transcranial direct current stimulation [tDCS] and peripheral electrical stimulation [PES]) have not been studied in low back pain patients.

The present study was conducted to compare the effect of three neuromodulatory protocols (anodal tDCS, high-intensity PES, and a priming protocol of combined tDCS/PES) on primary motor cortex (M1) excitability in people with and without chronic LBP. A total of ten individuals with chronic pain and ten pain-free controls were included in this cross-sectional study

Methods: 

Participants were randomized to receive four interventions across separate sessions: 1) anodal tDCS to M1 + PES to the back muscles; 2) tDCS + sham PES; 3) sham tDCS + PES, or 4) sham tDCS + sham PES.

Motor cortical excitability (map volume, discrete map peaks, and cortical silent period [CSP]) was estimated before and after each intervention.

Results: 

There was increase in M1 excitability (increased map volume and reduced CSP) with Anodal tDCS in controls but it did not affect the LBP group.

PES reduced M1 excitability in both groups. The combined tDCS + PES treatment increased M1 excitability in the LBP group but did not affect controls.

Conclusion: 

There is a difference in the neurophysiological response to common neuromodulatory treatments in people with and without LBP.  This criteria needs to be considered while designing and and tailoring neuromodulation in pain. In addition, if the prime aim of treatment is to improve M1 excitability, a priming protocol (e.g., combined tDCS + PES) seems to be more effective than tDCS alone.

 

Source

Pain Med pnx168.

Link to the source:

https://www.ncbi.nlm.nih.gov/pubmed/29016867

The original title of the article:

The Response of the Primary Motor Cortex to Neuromodulation is Altered in Chronic Low Back Pain: A Preliminary Study

Authors:

Siobhan M. Schabrun et al

Therapeutic, Low Back Pain, Spine, Chronic, Preliminary Cross-Sectional Study, Efficacy, Motor Cortical Excitability
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