Chronic back pain can be managed by stimulating the autonomic nervous system

With aging comes many changes in the human body – cells weaken and break down faster, bones weaken and standing for hours becomes difficult. For some people, standing straight also becomes a problem, and a larger population suffers from lower back pain. Low back pain is a very common reason for consultation with the doctor. Indeed, one of the changes in the human body that occurs as one ages is a reduction in the fluid content between the vertebrae. This causes contact between the vertebrae, resulting in pain.

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Back ache

Generally, the pain can be acute or chronic. Acute pain lasts from a few days to a few weeks. Acute pain becomes chronic when it lasts three to six months, however, how and why acute pain turns into chronic pain is still unclear. It has been found that in patients with chronic low back pain (CLBP), there is a change in the way the central nervous system processes pain in a way that alters the balance of the autonomic nervous system (ANS). This change is thought to be the reason why the pain persists. Studies have been conducted to find out why this change occurs, and how to stop it and restore the normal balance of ANS.

Noninvasive Brain Stimulation vs ANS Balance

Researchers have moved to discover the reason for the imbalance of the ANS during the occurrence of chronic pain. It is believed that this discovery would make it easier for doctors to effectively treat chronic pain. Since the brain is the control house of the human body, every stimulus, including pain, entering the body reaches the brain and its intensity is determined by the activities that take place in the brain after reaching it.

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During research, it was discovered that when chronic pain occurs, central nervous system activity affects the balance of the ANS outside of its normal levels during pain treatment. To restore this balance, a randomized, double-blind, crossover, simulation-controlled study was performed to determine if the use of transcranial alternating current stimulation (a form of non-invasive brain stimulation) would be effective.

ANS parameters from a previously published study of transcranial alternating current stimulation (tACS) were used. ANS parameters include heart rate variability (HRV) and respiratory sinus arrhythmia (RSA). HRV reflected the balance of parasympathetic and sympathetic ANS actions, while RSA reflected the balance of parasympathetic ANS action only. The study examined the results of 10Hz-tACS on the two ANS balance parameters as calculated from the electrocardiogram (ECG). Observations were taken 2 minutes before and after 40 minutes of 10Hz-tACS.

At the end of the study, there was no observable change in either measure. However, exploratory analyzes on HRV in the time domain showed a reasonable increase in the standard deviation of normal intervals between R peaks (SDNN), another measure of ANS balance with simulation.

Clinical significance

Although the noninvasive stimulation technique used had no significant effect on RSA, exploratory analysis of HRV revealed that ANS may be regulated by tACS. This means that balance can be restored and CLBP can be reduced. These results would contribute to the innovation of better procedures for the treatment of CLBP and a consequent reduction in the potentially disabled population it can cause.

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Conclusion

Chronic lower back pain remained a common cause of doctor visits, especially among older people. It is also known to be the second most common cause of disability in adults. This study provides a way to discover more effective treatment options.

References

Targeting 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