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The Effects of Cognitive Behavioral Therapy and Transcranial Current Stimulation (tDCS) on Chronic Lower Back Pain

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ClinicalTrials.gov Identifier: NCT02483468
Recruitment Status : Recruiting
First Posted : June 29, 2015
Last Update Posted : May 2, 2018
Sponsor:
Information provided by (Responsible Party):
Jeffrey Borckardt, Medical University of South Carolina

Brief Summary:
The primary objective of this study is to evaluate the effects of cognitive-behavioral therapy in combination with transcranial direct current stimulation in (1) improving pain and functionality, (2) reducing severity of opioid use disorders, and (3) reducing impairment in associated mental health areas (e.g., depression, anxiety, PTSD, sleep). The investigators will also determine the effects of treatment on neural activity in cognitive and limbic brain regions involved in pain regulation using functional magnetic resonance imaging (fMRI), and examine its relationship to opioid use severity.

Condition or disease Intervention/treatment Phase
Chronic Low Back Pain Opioid Use, Unspecified Behavioral: Cognitive Behavioral Therapy for Pain Device: Transcranial Direct Current Stimulation Device: Sham Transcranial Direct Current Stimulation Phase 2 Phase 3

Detailed Description:
As a result of sustained operations in Afghanistan and Iraq, an increasing number of U.S. military personnel and Veterans are in need of effective pain management treatment. Chronic low back pain (CLBP) is the most common pain condition among returning Veterans and is associated with high levels of opioid analgesic prescribing in VA clinics. Although opioids are effective for acute pain, they are not very effective as a long-term treatment strategy. Furthermore, opioids are associated with significantly increased risk of misuse, addiction, diversion, overdose and death. Consequently, there is a critical need for the development of alternative, effective treatments for CLBP that can be implemented in VA-based healthcare settings. The proposed study will answer critical questions regarding the ability of Transcranial Direct Current Stimulation (tDCS) to augment the effects of cognitive behavioral therapy (CBT) for pain, and elucidate possible mechanisms underlying improved outcomes. tDCS is inexpensive and highly portable, making it a very scalable tool to add to current CBT interventions within the VA healthcare system. This study has the particular advantages of building directly on positive preliminary findings among civilians and is being led by a multi-disciplinary team of experts who have successfully collaborated in the past and are uniquely qualified to implement this type of investigation. The primary objective of the proposed Stage II study is to evaluate the effects of CBT in combination with tDCS in (1) improving pain and functionality, (2) reducing severity of opioid use disorders, and (3) reducing impairment in associated mental health areas (e.g., depression, anxiety, PTSD, sleep). The investigators will also determine the effects of treatment on neural activity in cognitive and limbic brain regions involved in pain regulation using functional magnetic resonance imaging (fMRI), and examine its relationship to opioid use severity. Secondary objectives are to evaluate acute lab-based pain markers and neural correlates of improvement in chronic pain using quantitative sensory testing. In order to accomplish this the investigators are: using a manualized, evidence-based CBT intervention that is already widely-disseminated within the VA system; employing a randomized, between-groups, double-blind experimental design; and examining standardized, repeated, dependent measures of change in: (a) clinical outcomes such as pain, opioid and other substance use disorders (e.g., alcohol, illicit drugs, other prescription drugs), depression, anxiety, sleep and PTSD symptomatology; and (b) process variables such as participant satisfaction, quality of life and treatment retention. The results of this study will provide important information regarding two non-pharmacologic, evidence-based interventions (CBT and tDCS), and will help inform policies and programs to better serve the needs of U.S. military personnel, Veterans, and their families. The findings from this study may help reduce public health costs and morbidity/mortality associated with chronic pain and co-morbid prescription opiate use disorders among our nation's Veterans.

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 120 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary Purpose: Treatment
Official Title: The Effects of Cognitive Behavioral Therapy and Transcranial Current Stimulation (tDCS) on Chronic Lower Back Pain
Study Start Date : January 2015
Estimated Primary Completion Date : January 2020
Estimated Study Completion Date : June 2020

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Back Pain

Arm Intervention/treatment
Experimental: tDCS
Active Transcranial Direct Current Stimulation - Stimulation of the left dorsolateral prefrontal cortex with 2mA of electrical current
Behavioral: Cognitive Behavioral Therapy for Pain
Cognitive-behavioral therapy (CBT) for pain management takes an active problem-solving approach to tackling the many challenges associated with the experience of chronic pain. Rather than seeing ones self as helpless and disabled because of pain, CBT encourages individuals to take back control and re-engage in activities.
Other Name: CBT

Device: Transcranial Direct Current Stimulation
Electrical stimulation of the prefrontal cortex using 2mA of direct current
Other Name: tDCS

Sham Comparator: tDCS (sham)
Inactive (sham) Transcranial Direct Current Stimulation
Behavioral: Cognitive Behavioral Therapy for Pain
Cognitive-behavioral therapy (CBT) for pain management takes an active problem-solving approach to tackling the many challenges associated with the experience of chronic pain. Rather than seeing ones self as helpless and disabled because of pain, CBT encourages individuals to take back control and re-engage in activities.
Other Name: CBT

Device: Sham Transcranial Direct Current Stimulation
Sham stimulation of the left dorsolateral prefrontal cortex
Other Name: Sham tDCS




Primary Outcome Measures :
  1. Pain perception [ Time Frame: 10 weeks ]
    Average daily pain (electronic diary), Pain unpleasantness (electronic diary) and functional impairment due to pain (Brief Pain Inventory).


Secondary Outcome Measures :
  1. Opioid misuse [ Time Frame: 10 weeks ]
    Current Opioid Misuse Measure scores and opiate craving ratings (electronic diary)

  2. Psychiatric functioning [ Time Frame: 10 weeks ]
    Depression (BDI-II), Anxiety (BAI), PTSD (PCL-M) and Sleep (PSQI).


Other Outcome Measures:
  1. Brain activation at baseline [ Time Frame: 1 week ]
    fMRI percent signal change in the left DLPFC during pain blocks as well as signal in the left insula, ACC, thalamus, caudate, putamen, and medial prefrontal cortex.

  2. Brain activation changes [ Time Frame: 10 weeks ]
    Percent BOLD signal change in the left DLPFC during pain blocks will be compared between the CBT + real tDCS group and the CBT + sham tDCS group.

  3. Laboratory pain assessment (Quantitative sensory testing; QST) at baseline [ Time Frame: 1 week ]
    Pain perception ratings using standardized labratory pain procedures

  4. Laboratory pain assessment (Quantitative sensory testing; QST) changes [ Time Frame: 10 weeks ]
    Pain perception changes using standardized labratory pain procedures



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Treatment-seeking OEF/OIF/OND Veterans (including National Guard and Reservists) ages 18 through 65
  • Chronic Lower Back pain (ICD-9 Diagnosis code 724; BPI pain on average score>4/10; ≥3 months duration of pain)
  • Prescription opiate use disorder (past 6 months; COMM score >13).

Exclusion Criteria:

  • Latex Allergy
  • Pregnant
  • No current chronic lower back pain (3 months<)
  • Not taking opiates/pain medication
  • Psychiatric Condition Preventing successful engagement in CBT
  • Current Medications that lower seizure threshold
  • Other major medical problem (e.g., history of seizures)
  • Unable or unwilling discontinue current behavioral therapy

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02483468


Contacts
Contact: Jeffrey J Borckardt, Ph.D. (843) 792-3659 borckard@musc.edu

Locations
United States, South Carolina
Medical University of South Carolina Recruiting
Charleston, South Carolina, United States, 29425
Contact: Jeffery Borckardt, PhD    843-792-3659      
Principal Investigator: Jeffery Borckardt, PhD         
Sponsors and Collaborators
Medical University of South Carolina
Investigators
Principal Investigator: Jeffrey J Borckardt, Ph.D. Medical University of South Carolina

Responsible Party: Jeffrey Borckardt, Professor, Medical University of South Carolina
ClinicalTrials.gov Identifier: NCT02483468     History of Changes
Other Study ID Numbers: Pro00036590
First Posted: June 29, 2015    Key Record Dates
Last Update Posted: May 2, 2018
Last Verified: May 2018

Additional relevant MeSH terms:
Back Pain
Low Back Pain
Pain
Neurologic Manifestations
Nervous System Diseases
Signs and Symptoms