Combining Brain Stimulation and Physiotherapy for the Management of Chronic Low Back Pain
Trial Parameters
Brief Summary
Chronic low back pain (CLBP) is a major health challenge in Canada, leading to substantial disability and socioeconomic burden, particularly among Veterans. In military Veterans, LBP is the most common chronic pain condition. Conventional interventions have limited effectiveness. The refractoriness to interventions suggests that specific CLBP mechanisms may be missed by current treatments, prompting a shift towards psychologically informed approaches which aim to address emotional and cognitive factors alongside biomedical aspects. The integration of these concepts into physiotherapy is called psychologically informed physiotherapy (PiP). Despite promising results of PiP from randomized controlled trials, residual pain and disability often persist in Veterans. Non-invasive brain stimulation, such as repetitive transcranial magnetic stimulation (rTMS), may enhance the effectiveness of PiP by modulating cognition, emotion, and pain. This proposal seeks to determine whether non-invasive brain stimulation can enhance the effects of PiP.
Eligibility Criteria
Inclusion Criteria: * Adults between 18 and 65 years old * Military Veterans with non-specific chronic low back pain (\> 3 months, \> 50% of the days in the last 6 months) * High level of psychosocial factors, scoring ≥4 on the Start Back Screening Tool * Functional limitations, scoring ≥ 15% on the Oswestry Disability Index (ODI) Exclusion Criteria: * Non-musculoskeletal conditions causing low back pain (e.g., neoplasia, fracture) * Diagnosis of drug or alcohol abuse * Change of drug dosage in the last month for the treatment of pain or mental health * Presenting with any specific rTMS-related exclusion criteria such as previous seizure/convulsion, cochlear implant, and pregnancy