Efeitos da estimulação transcraniana por corrente contínua na dor lombar crônica não específica

Abstract

Introduction: Low back pain is highly prevalent and the leading cause of disability in developed countries, with higher incidence in women. The persistence of symptoms for more than three months characterizes chronic low back pain (CLBP). Among exercise-based interventions for managing CLBP, the Pilates method has well-established efficacy. Transcranial direct current stimulation (tDCS), in turn, has been investigated as a complementary approach. Preliminary evidence indicates that the combination of tDCS and physical exercises may enhance pain reduction and promote relevant clinical improvements. Objective: To investigate the effects of the simultaneous application of tDCS with exercises based on the Pilates method on pain and muscle strength in individuals with CLBP. Methodology: This is a pilot study of a randomized clinical trial with a sample of 36 women with a history of low back pain for more than 12 weeks and a minimum intensity of 3 points on the numerical pain scale (NPS). Three weekly treatment sessions were conducted over four weeks at the Department of Physical Therapy of the Federal University of Rio Grande do Norte. Subjects were randomized into two groups: the ACTIVE group (AG): tDCS combined with a physical exercise protocol; and the sham group (SG): the same exercise protocol combined with sham tDCS. Participants underwent three assessments: T0 (before the intervention), T1 (after four weeks of intervention), and T2 (one month after the end of the intervention). Pain in the last 24 hours was assessed using the NPS, and trunk extensor muscle strength was assessed using a hand-held dynamometer. Results: Of the 36 eligible women at the beginning of the study, 26 completed the follow-up (T2). In the intragroup analysis, both groups showed significant improvements in pain and muscle strength between T0 and T1. In the SG, there was an average reduction of 3.8 points in pain over the last 24 hours according to the NPS (p<0.01); in the AG, the reduction was 2.7 points (p=0.01). As for muscle strength, there were no significant changes in this variable. In the intergroup comparison, there was no significant difference in any variable at the assessed time points. Conclusion: The simultaneous application of tDCS with a Pilates exercise protocol did not enhance analgesic effects nor promote changes in muscle strength in women with chronic low back pain. Thus, the improvements observed in both groups may be attributed to the benefits of the exercises.