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Targeting the Autonomic Nervous System Balance in Patients with Chronic Low Back Pain Using Transcranial Alternating Current Stimulation: A Randomized, Crossover, Double-Blind, Placebo-Controlled Pilot Study

Authors Prim JH, Ahn S, Davila MI, Alexander ML, McCulloch KL, Fröhlich F

Received 8 March 2019

Accepted for publication 1 November 2019

Published 11 December 2019 Volume 2019:12 Pages 3265—3277

DOI https://doi.org/10.2147/JPR.S208030

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr E Alfonso Romero-Sandoval


Julianna H Prim,1–3,* Sangtae Ahn,1,2,* Maria I Davila,1 Morgan L Alexander,1,2 Karen L McCulloch,3,4,* Flavio Fröhlich1,2,5–8,*

1Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; 2Carolina Center for Neurostimulation, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; 3Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; 4Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; 5Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; 6Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; 7Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; 8Neuroscience Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA

*These authors contributed equally to this work

Correspondence: Flavio Fröhlich
University of North Carolina at Chapel Hill 116 Manning Dr, Mary Ellen Jones Building 6018, Chapel Hill, NC 27599, USA
Tel +1 919 966 4584
Email flavio_frohlich@med.unc.edu

Background: Chronic low back pain (CLBP) is characterized by an alteration in pain processing by the central nervous system that may affect autonomic nervous system (ANS) balance. Heart rate variability (HRV) reflects the balance of parasympathetic and sympathetic ANS activation. In particular, respiratory sinus arrhythmia (RSA) solely reflects parasympathetic input and is reduced in CLBP patients. Yet, it remains unknown if non-invasive brain stimulation can alter ANS balance in CLBP patients.
Objective: To evaluate if non-invasive brain stimulation modulates the ANS, we analyzed HRV metrics collected in a previously published study of transcranial alternating current stimulation (tACS) for the modulation of CLBP through enhancing alpha oscillations. We hypothesized that tACS would increase RSA.
Methods: A randomized, crossover, double-blind, sham-controlled pilot study was conducted to investigate the effects of 10Hz-tACS on metrics of ANS balance calculated from electrocardiogram (ECG). ECG data were collected for 2 mins before and after 40 mins of 10Hz-tACS or sham stimulation.
Results: There were no significant changes in RSA or other frequency-domain HRV components from 10Hz-tACS. However, exploratory time-domain HRV analyses revealed a significant increase in the standard deviation of normal intervals between R-peaks (SDNN), a measure of ANS balance, for 10Hz-tACS relative to sham.
Conclusion: Although tACS did not significantly increase RSA, we found in an exploratory analysis that tACS modulated an integrated HRV measure of both ANS branches. These findings support the further study of how the ANS and alpha oscillations interact and are modulated by tACS.
ClinicalTrials.gov: Transcranial Alternating Current Stimulation in Back Pain – Pilot Study, NCT03243084.

Keywords: low back pain, autonomic nervous system, heart rate variability, transcranial alternating current stimulation

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