U.S. Veterans with low back pain benefit from transcranial direct current stimulation: Results from a cognitive...

Chronic low back pain is common among Veterans and is associated with functional impairment and prescription opioid misuse. Cognitive Behavioral Therapy for Chronic Pain is the VA's recommended nonpharmacologic treatment, yet many patients experience modest improvements, underscoring the need for adjunctive strategies. Transcranial Direct Current Stimulation, a low-risk neuromodulation technique, has demonstrated analgesic and cognitive-affective benefits and may augment behavioral pain treatment. This double-blind, randomized controlled trial (NCT02483468) examined whether adding Transcranial Direct Current Stimulation to Cognitive Behavioral Therapy for Chronic Pain improved pain, functional impairment, and opioid misuse among Veterans with chronic low back pain and prescription opioid misuse. Veterans (N=115) were randomized to real or sham Transcranial Direct Current Stimulation administered during 11 Cognitive Behavioral Therapy for Chronic Pain sessions and completed repeated assessments of pain, functional impairment, and opioid misuse from baseline through follow-up. Mixed-effects models indicated significant time × group interactions for both pain and functional impairment, with participants receiving real Transcranial Direct Current Stimulation demonstrating a steeper decline across study timepoints. Opioid misuse decreased significantly over time in both groups, without additional benefit from Transcranial Direct Current Stimulation. Transcranial Direct Current Stimulation may meaningfully enhance the trajectory of pain and functional recovery during Cognitive Behavioral Therapy for Chronic Pain. Although adding Transcranial Direct Current Stimulation did not improve opioid misuse over the study period, the accelerated gains in pain and functioning may have downstream effects. Overall, Transcranial Direct Current Stimulation appears to be a promising adjunct that may accelerate recovery during behavioral pain treatment. PERSPECTIVE: Adding Transcranial Direct Current Stimulation to Cognitive Behavioral Therapy for Chronic Pain accelerates reductions in pain and functional impairment among Veterans with chronic low back pain, even when end-of-treatment scores are similar. Faster treatment gains may enhance engagement and reduce disability burden, highlighting the clinical value of neuromodulation.