Chronic low back pain (CLBP) is a major health challenge in Canada, leading to substantial disability and socioeconomic burden, particularly among Veterans. In military Veterans, LBP is the most common chronic pain condition. Conventional interventions have limited effectiveness. The refractoriness to interventions suggests that specific CLBP mechanisms may be missed by current treatments, prompting a shift towards psychologically informed approaches which aim to address emotional and cognitive factors alongside biomedical aspects. The integration of these concepts into physiotherapy is called psychologically informed physiotherapy (PiP). Despite promising results of PiP from randomized controlled trials, residual pain and disability often persist in Veterans. Non-invasive brain stimulation, such as repetitive transcranial magnetic stimulation (rTMS), may enhance the effectiveness of PiP by modulating cognition, emotion, and pain. This proposal seeks to determine whether non-invasive brain stimulation can enhance the effects of PiP.
Adults between 18 and 65 years old
Military Veterans with non-specific chronic low back pain (> 3 months, > 50% of the days in the last 6 months)
High level of psychosocial factors, scoring ≥4 on the Start Back Screening Tool
Functional limitations, scoring ≥ 15% on the Oswestry Disability Index (ODI)
Non-musculoskeletal conditions causing low back pain (e.g., neoplasia, fracture)
Diagnosis of drug or alcohol abuse
Change of drug dosage in the last month for the treatment of pain or mental health
Presenting with any specific rTMS-related exclusion criteria such as previous seizure/convulsion, cochlear implant, and pregnancy
Laval University
Lead sponsor
Chronic Pain Centre of Excellence for Canadian Veterans
Collaborator
Foundation for Physical Medicine and Rehabilitation
Collaborator