Comparison of the Effectiveness of Cognitive Behavioral Therapy with and without Transcranial Direct Current Stimulation on Pain-Related Disability in Patients with Musculoskeletal Pain

Document Type : Research Paper

Authors

1 Student

2 Professor

Abstract

Background and Objective: Musculoskeletal pain is one of the major causes of disability, and comparing the effectiveness of cognitive-behavioral therapy (CBT) with and without Transcranial direct current stimulation may play a crucial role in improving pain-related dysfunction. The present study aimed to compare the effectiveness of CBT, with and without transcranial direct current stimulation, on pain-related disability in patients with musculoskeletal pain.
Method: This applied quasi-experimental study employed a pretest–posttest design with a follow-up phase and a non-equivalent control group. A total of 45 patients with chronic musculoskeletal pain and a minimum pain duration of three months in the lower back, neck, and shoulder regions, who had referred to specialized orthopedic clinics in Sirjan, were selected by convenience sampling and allocated into three groups of 15 participants each: CBT with tDCS, CBT without tDCS, and control. The experimental groups received 12 sessions of group-based CBT according to McFarlane’s protocol, and the combined group additionally underwent 20 sessions of transcranial direct current stimulation at 2 mA targeting the dorsolateral prefrontal cortex. Pain-related disability was assessed using the Roland–Morris Disability Questionnaire (Roland & Morris, 1981). Data were analyzed using repeated-measures ANCOVA and Bonferroni post-hoc tests in SPSS version 26.
Results: ANCOVA results indicated a significant effect of group on pain-related disability. Both CBT groups—with and without tDCS—showed significantly greater reductions in disability compared to the control group (F = 66/556). Although the difference between the two experimental groups was not statistically significant (p>0.05), the combined group demonstrated slightly greater improvement.
Conclusion: The findings indicate that CBT is an effective intervention for reducing pain-related disability, and although tDCS appears to enhance these effects, its statistical advantage was not confirmed. Therefore, while CBT remains a robust therapeutic approach, further research is needed to determine the definitive added value of combining it with tDCS.

Keywords

Clinical Psychology Studies
Volume 16, Issue 61
December 2025

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