The anode was placed over the left motor cortex, while the cathode was placed supraorbitally on the contralateral side, and both were held in place by elastic bandages. The electricity was slowly increased to 2 mA at the beginning of the stimulation (eight seconds fade in) and slowly decreased at the end of the stimulation (eight seconds fade out) to reduce skin sensations underneath the electrodes.44 Single pulse transcranial magnetic stimulation (Magstim Company, Dyfed, UK) was applied to accurately determine the location of the left motor cortex (abductor digiti minimi) with a standard protocol.45 46Outcome measuresTranscranial direct current stimulation and cognitive behavioural management have different suggested roles within the management of non specific chronic low back pain. Transcranial direct current stimulation directly targets pain processing areas within the brain, aiming to reduce pain intensity; this was therefore essential as a primary outcome measure.Flowchart for trial of effectiveness of anodal or sham transcranial direct current stimulation (tDCS) alone and before cognitive behavioural management (CBT) for patients with chronic low back painFig 1 Flowchart for trial of effectiveness of anodal or sham transcranial direct current stimulation (tDCS) alone and before cognitive behavioural management (CBT) for patients with chronic low back painOpen in new tabBased on the two primary outcome measures and the two primary endpoints, we calculated the sample size at an level of 0.0125 (90% power).57 58 Based on recommendations for a minimum clinically relevant change of 15 mm on a 0 100 mm visual analogue scale for pain59 and 8 points on the Oswestry disability index,60 and allowing for a dropout rate of 12% after transcranial direct current stimulation61 and a further 16% after the cognitive behavioural management,62 we required 135 participants.
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