Combining Non-invasive Brain Stimulation and Exercise to Treat Low Back Pain

NCT ID: NCT04555278

Last Updated: 2026-01-20

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

140 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-09-25

Study Completion Date

2024-03-01

Brief Summary

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The aim of this study is to evaluate the efficacy of repetitive transcranial magnetic stimulation alone and in combination with motor control exercises on pain and disability for patients with chronic non-specific low back pain.

Detailed Description

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Conditions

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Chronic Low-back Pain

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Pseudo-factorial design (rTMS: Active/Sham \| Exercises: Yes/No)
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
Participants will be masked to rTMS intervention (real or sham) but cannot be blinded to the exercise intervention. However, participants will not be aware of the study design (other arms).

Therapist delivering the exercise intervention will be masked to rTMS intervention (active vs. sham) but cannot be blinded to exercise intervention (yes vs. no).

Experimenter delivering the rTMS intervention will be masked to exercise intervention but not to rTMS intervention (real or sham).

Outcomes assessor will be completely masked to all interventions as all outcomes are questionnaires that will be completed online. Data will be de-identified and the data analyst will be masked to participants and group allocation.

Study Groups

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Active rTMS + Motor control exercises

Active (real) repetitive transcranial magnetic stimulation (20 minutes), immediately followed by a session of motor control exercises taught and supervised by a physiotherapist (30 minutes).

Group Type EXPERIMENTAL

Active rTMS

Intervention Type DEVICE

A figure-of-8 coil connected to a biphasic Magstim Rapid 2 stimulator (The MagstimCo, Whitland, UK) will be used. Coil orientation and position will be guided throughout the experiment by a neuronavigation system (Brainsight, Rogue research, Montreal, QC, Canada). The intensity of rTMS will be set at 95 % of the first dorsal interosseous (FDI) resting motor threshold (RMT).

Active rTMS will consist of 40 trains of 5 seconds each at 10 Hz (25-s intertrain interval) applied over M1 (on FDI cortical representation), for a total of 2000 stimulations lasting 20 minutes.

Motor Control Exercises

Intervention Type OTHER

The rehabilitation program will consist of a 30-minute session of motor control exercises following the rTMS (Active or Sham) intervention. This approach aims to improve spine health through the optimization of spine loading. The first session will be preceded by an individualized evaluation of the participant's abilities and deficiencies to tailor the training program to each participant.

Sham rTMS + Motor control exercises

Sham repetitive transcranial magnetic stimulation (20 minutes), immediately followed by a session of motor control exercises taught and supervised by a physiotherapist (30 minutes).

Group Type SHAM_COMPARATOR

Sham rTMS

Intervention Type DEVICE

A sham coil will be use (e.g. equipped with a magnetic shield that blocks the magnetic field). The sham stimulation will last the same duration as the active rTMS (30 min).

Motor Control Exercises

Intervention Type OTHER

The rehabilitation program will consist of a 30-minute session of motor control exercises following the rTMS (Active or Sham) intervention. This approach aims to improve spine health through the optimization of spine loading. The first session will be preceded by an individualized evaluation of the participant's abilities and deficiencies to tailor the training program to each participant.

Active rTMS

Active (real) repetitive transcranial magnetic stimulation (20 minutes).

Group Type EXPERIMENTAL

Active rTMS

Intervention Type DEVICE

A figure-of-8 coil connected to a biphasic Magstim Rapid 2 stimulator (The MagstimCo, Whitland, UK) will be used. Coil orientation and position will be guided throughout the experiment by a neuronavigation system (Brainsight, Rogue research, Montreal, QC, Canada). The intensity of rTMS will be set at 95 % of the first dorsal interosseous (FDI) resting motor threshold (RMT).

Active rTMS will consist of 40 trains of 5 seconds each at 10 Hz (25-s intertrain interval) applied over M1 (on FDI cortical representation), for a total of 2000 stimulations lasting 20 minutes.

Sham rTMS

Sham repetitive transcranial magnetic stimulation (20 minutes).

Group Type SHAM_COMPARATOR

Sham rTMS

Intervention Type DEVICE

A sham coil will be use (e.g. equipped with a magnetic shield that blocks the magnetic field). The sham stimulation will last the same duration as the active rTMS (30 min).

Interventions

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Active rTMS

A figure-of-8 coil connected to a biphasic Magstim Rapid 2 stimulator (The MagstimCo, Whitland, UK) will be used. Coil orientation and position will be guided throughout the experiment by a neuronavigation system (Brainsight, Rogue research, Montreal, QC, Canada). The intensity of rTMS will be set at 95 % of the first dorsal interosseous (FDI) resting motor threshold (RMT).

Active rTMS will consist of 40 trains of 5 seconds each at 10 Hz (25-s intertrain interval) applied over M1 (on FDI cortical representation), for a total of 2000 stimulations lasting 20 minutes.

Intervention Type DEVICE

Sham rTMS

A sham coil will be use (e.g. equipped with a magnetic shield that blocks the magnetic field). The sham stimulation will last the same duration as the active rTMS (30 min).

Intervention Type DEVICE

Motor Control Exercises

The rehabilitation program will consist of a 30-minute session of motor control exercises following the rTMS (Active or Sham) intervention. This approach aims to improve spine health through the optimization of spine loading. The first session will be preceded by an individualized evaluation of the participant's abilities and deficiencies to tailor the training program to each participant.

Intervention Type OTHER

Other Intervention Names

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Repetitive Transcranial Magnetic Stimulation Sham Repetitive Transcranial Magnetic Stimulation

Eligibility Criteria

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Inclusion Criteria

* chronic low back pain, defined as "pain in the low back area with or without leg pain above the knee limiting activities or daily routine which has been present for more than 3 months";
* a minimal average pain intensity of 3 out of 10 during the preceding week on a pain numerical rating scale;
* a minimal score of 10 points on the Oswestry disability index (ODI).

Exclusion Criteria

* specific spinal pathology (fracture, tumor, radiculopathy, spinal infection, etc.);
* a history of back surgery;
* a major orthopedic, neurological, cardiovascular or psychiatric illness;
* low back pain is not the main pain complaint;
* currently using an exercise program to treat their LBP;
* previous use of repetitive transcranial magnetic stimulation.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Pfizer

INDUSTRY

Sponsor Role collaborator

The Canadian Pain Society

OTHER

Sponsor Role collaborator

Canadian Institutes of Health Research (CIHR)

OTHER_GOV

Sponsor Role collaborator

Hugo Massé-Alarie

OTHER

Sponsor Role lead

Responsible Party

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Hugo Massé-Alarie

Associate Professor, Medicine Faculty, Department of Rehabilitation

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Hugo Massé-Alarie, PhD

Role: PRINCIPAL_INVESTIGATOR

Laval University

Locations

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CIRRIS (Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale)

Québec, Quebec, Canada

Site Status

Countries

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Canada

References

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Patricio P, Tittley J, Lucas de Oliveira FC, Roy M, Fakhry N, Macedo LG, Hodges PW, Leonard G, Roy JS, Masse-Alarie H. Repetitive Transcranial Magnetic Stimulation and Motor Control Exercise for Chronic Low Back Pain: The ExTraStim Randomized Placebo-Controlled Trial. J Orthop Sports Phys Ther. 2026 Jan;56(1):1-10. doi: 10.2519/jospt.2025.13681.

Reference Type RESULT
PMID: 41385357 (View on PubMed)

Patricio P, Roy JS, Macedo L, Roy M, Leonard G, Hodges P, Masse-Alarie H. Repetitive transcranial magnetic stimulation alone and in combination with motor control exercise for the treatment of individuals with chronic non-specific low back pain (ExTraStim trial): study protocol for a randomised controlled trial. BMJ Open. 2021 Mar 24;11(3):e045504. doi: 10.1136/bmjopen-2020-045504.

Reference Type DERIVED
PMID: 33762244 (View on PubMed)

Other Identifiers

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2020-1844

Identifier Type: -

Identifier Source: org_study_id

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