This systematic review and meta-analysis evaluates the efficacy of transcranial direct current stimulation (tDCS) for managing pain and disability in patients with chronic lower back pain.

Chronic lower back pain (LBP) is a leading cause of global disability, necessitating the development of safer and more effective therapeutic strategies. While tDCS, a non-invasive neuromodulation technique, has emerged as a potential treatment, its clinical efficacy remains uncertain, with existing evidence yielding inconsistent results.

We systematically searched PubMed, Web of Science, Ovid, and the Cochrane Library for randomized controlled trials (RCTs) evaluating tDCS in adults with chronic LBP. Primary outcomes were pain intensity, measured via the Visual Analogue Scale (VAS), Numerical Rating Scale (NRS), or Defense and Veterans Pain Rating Scale (DVPRS), and disability, assessed using the Roland-Morris Disability Questionnaire (RMDQ) or Oswestry Disability Index (ODI/MODI). Secondary outcomes included quality of life (QOL), measured by the EuroQol-5D (EQ-5D) and Short Form-36 (SF-36).  A meta-analysis was conducted using a random-effects model to calculate the standardized mean difference (SMD), along with 95% confidence intervals (CI).

Our meta-analysis included 16 RCTs with a total of 672 patients with chronic LBP. Compared to sham stimulation, active tDCS demonstrated a statistically significant reduction in both pain intensity (SMD: -0.68; 95% CI: -1.05 to -0.31; p = 0.0003) and disability (SMD: -0.51; 95% CI: -0.95 to -0.07; p = 0.02). In contrast, no significant improvement in QOL was observed between the active tDCS and sham groups.

tDCS showed significant improvement in patients with chronic LBP. To establish the long-term efficacy and clinical role of this intervention, future studies with standardized protocols, larger populations, and extended follow-up periods are necessary.