Testing Combined Brain Stimulation and Psychologically Informed Physiotherapy to Improve Chronic Low Back Pain in Veterans

What this Trial Is About

Chronic low back pain CLBP is a significant health issue among military Veterans in Canada, often causing disability and economic challenges. Current treatments have limited success, especially as they may miss important emotional and cognitive factors influencing pain. This trial investigates whether adding non-invasive brain stimulation called repetitive transcranial magnetic stimulation rTMS to psychologically informed physiotherapy PiP can better improve physical function in Veterans with CLBP and related psychological challenges. Participants will be randomly assigned to one of three groups active rTMS combined with PiP, sham placebo rTMS combined with PiP, or usual physiotherapy UP. The study involves an 8-week intervention period. In the first two weeks, brain stimulation sessions occur daily, then from weeks 3 to 8, brain stimulation and physiotherapy are given separately twice a week. Usual physiotherapy participants receive six sessions spread over eight weeks. PiP includes strategies addressing psychological and behavioral aspects alongside physical therapy, supported by an educational website. Throughout the study, participants complete validated questionnaires measuring physical function, pain intensity, quality of life, fear of movement, depression, self-efficacy, post-traumatic stress symptoms, medication use, and overall change. These assessments occur at baseline, 2, 8, and 26 weeks after starting treatment. The study aims to determine if combining rTMS with PiP improves outcomes more than either treatment alone, with follow-up extending to six months to monitor lasting effects and safety.

Combining Brain Stimulation and Physiotherapy for the Management of Chronic Low Back Pain