Effects of a transcranial direct current stimulation protocol combined with Pilates-based exercises in the treatment of chronic low back pain: randomised controlled trial
Exercise Therapy, Rehabilitation, Neuromodulation, Musculoskeletal Pain, Analgesia.
Introduction: Chronic low back pain (CLBP) is a multifactorial condition with a significant impact on functionality and quality of life. Transcranial Direct Current Stimulation (tDCS) is a non-invasive neuromodulation technique that modulates cortical excitability, influencing pain perception. It has been explored as a promising approach in the treatment of chronic pain, however, with no consensus about CLBP. Conversely, physical exercise, such as Pilates, is already widely recommended in reducing pain and improving functionality in these patients. Objective: To investigate the effects tDCS combined with Pilates-based exercises in individuals with CLBP. Methodology: A double-blind randomized controlled trial was conducted with 36 participants randomly assigned into two groups: active tDCS + Pilates (ATP) and sham tDCS + Pilates (STP). Pain intensity, disability, pressure pain threshold, and quality of life were assessed before and after four weeks of intervention, as well as one month after the end of the treatment. Results: There were no statistically significant differences between the groups for all analyzed variables (p > 0.05). Despite this, both groups showed improvements over time compared to baseline in pain (p < 0.001), disability (p < 0.001), pressure pain threshold at L5 (p = 0.005), and in the SF-36 domains - functional capacity (p = 0.003), social aspects (p = 0.045), general health (p = 0.006), and emotional aspects (p = 0.009). Conclusion: Transcranial Direct Current Stimulation did not promote additive effects when combined with Pilates-based exercises in individuals with chronic low back pain.