- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02483468
The Effects of Cognitive Behavioral Therapy and Transcranial Current Stimulation (tDCS) on Chronic Lower Back Pain
January 27, 2023 updated by: Jeffrey Borckardt, Medical University of South Carolina
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.
Study Overview
Status
Completed
Conditions
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
Enrollment (Actual)
160
Phase
- Phase 2
- Phase 3
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
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South Carolina
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Charleston, South Carolina, United States, 29425
- Medical University of South Carolina
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years to 70 years (ADULT, OLDER_ADULT)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Ages 18 to 70.
- United States Veteran or family member of a Veteran.
- Able to provide informed consent and function at an intellectual level sufficient to allow accurate completion of the assessment instruments.
- Subjects must be able to comprehend English.
- Have a chronic pain condition and ≥3months duration of pain.
- BPI score >4/10.
- Meet DSM-5 criteria for current (i.e., past 6 months) prescription opioid use disorder (assessed via the MINI 7.0).
- COMM score>7.
- Subjects may also meet criteria for a mood disorder if asymptomatic or anxiety disorders (PTSD, panic disorder, agoraphobia, social phobia, generalized anxiety disorder, or obsessive compulsive disorder). The inclusion of subjects with affective and anxiety disorders is essential because of the marked frequency of the co-existence of mood and other anxiety disorders among patients with chronic pain and prescription opioid use disorders.
- Subjects taking psychotropic medications will be required to be maintained on a stable dose for at least four weeks before study initiation. This is because initiation or change of psychotropic medications during the course of the trial may interfere with interpretation of results.
- Must consent to random assignment to CBT + tDCS or CBT + sham tDCS.
- Must consent to complete all treatment and follow-up visits.
- Must live within 100 miles of the Medical University of South Carolina.
Exclusion Criteria:
- Subjects with symptomatic psychotic/bipolar disorder and/or deemed too high risk by the study physician
- Subjects with current suicidal or homicidal ideation and intent.
- Subjects with a current eating disorder (bulimia, anorexia nervosa) or with dissociative identity disorder, as they are likely to require specific time-intensive psychotherapy in addition to the proposed therapy for stabilization.
- Subjects who would present a serious suicide risk or who are likely to require hospitalization during the course of the study.
- Subjects enrolled in ongoing behavioral therapy for pain or substance use disorders, who are not willing to discontinue these therapies for the duration of the trial. Attendance at therapeutic activities other than study sessions will be closely monitored using the Treatment Services Review.
- Subjects on maintenance anxiolytic, antidepressant, or mood stabilizing medications, which have been initiated during the past 4 weeks. If it is determined, based on clinical criteria, that a subject needs to be started on maintenance medications for anxiety, mood or psychotic symptoms during the course of the study, they will be discontinued from the treatment trial.
- Subjects with organic mental syndrome.
- Pregnant women.
- History of seizures.
- Implanted medical devices above the waist.
- Latex allergy.
- Diagnosis of Fibromyalgia.
- History of eczema or other sensitive skin conditions.
- Known brain tumors or lesions that intersect the area of stimulation.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: DOUBLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: tDCS
Active Transcranial Direct Current Stimulation - Stimulation of the left dorsolateral prefrontal cortex with 2mA of electrical current
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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 Names:
Electrical stimulation of the prefrontal cortex using 2mA of direct current
Other Names:
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SHAM_COMPARATOR: tDCS (sham)
Inactive (sham) Transcranial Direct Current Stimulation
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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 Names:
Sham stimulation of the left dorsolateral prefrontal cortex
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Average Daily Pain
Time Frame: 3 months
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Average daily pain defined by item #5 on the Brief Pain Inventory (BPI).
Scale on scale of 0-10; anchored with "0-no pain" and "10- pain as bad as you can imagine."
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3 months
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Pain Interference
Time Frame: 3 months
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Pain interference defined by the mean of items 9.a ---9.i; the measure is scored on a scale of 0--10, anchored by "0-does not interfere" and "10- completely interferes"
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3 months
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Pain Catastrophizing
Time Frame: 3 months
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Pain catastrophizing defined by total score of 13 items pain catastrophizing scale.
This measure has a total score range of 0-52 where for each item is anchored by "0-not at all" and "4-all the time."
Larger total score indicates more catastrophizing.
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3 months
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Opioid Misuse
Time Frame: 3 months
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Current Opioid Misuse Measure scores.
17-item Likert-type scale (For each opioid misuse risk behavior item, 0="Never and 4="Very often").
Possible range is 0 to 68.
Higher scores indicate more opioid misuse concerns.
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3 months
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Psychiatric Functioning (Depression)
Time Frame: 3 months
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Depression: Beck Depression Inventory-II (BDI-II): The Beck Depression Inventory (BDI) is a 21-item, self-report rating inventory that measures characteristic attitudes and symptoms of depression.
Possible range is 0 to 63 points.
Higher scores mean more depression symptoms.
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3 months
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Psychiatric Functioning (Anxiety)
Time Frame: 3 Months
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Beck Anxiety Inventory (BAI): 21-item self-report inventory used to assess anxiety levels in adults and adolescents.
The score range is 0-63.
Higher scores mean more anxiety symptoms.
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3 Months
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Psychiatric Functioning (PTSD)
Time Frame: 3 Months
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PTSD Checklist (PCL) 20-item self-report measure of the DSM-5 symptoms of PTSD: Score range: 0-80.
Higher scores mean more post-traumatic stress symptoms.
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3 Months
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Psychiatric Functioning (Sleep)
Time Frame: 3 Months
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The Pittsburgh Sleep Quality Index (PSQI) is a self-rated.
questionnaire which assesses sleep quality and disturbances.
Range of scores: 0-21.
Higher scores mean more sleep disturbance.
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3 Months
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: Jeffrey J Borckardt, Ph.D., Medical University of South Carolina
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (ACTUAL)
August 1, 2015
Primary Completion (ACTUAL)
April 28, 2021
Study Completion (ACTUAL)
April 28, 2021
Study Registration Dates
First Submitted
June 12, 2015
First Submitted That Met QC Criteria
June 24, 2015
First Posted (ESTIMATE)
June 29, 2015
Study Record Updates
Last Update Posted (ACTUAL)
February 10, 2023
Last Update Submitted That Met QC Criteria
January 27, 2023
Last Verified
January 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- Pro00036590
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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