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This exploratory study aimed to examine the effects of combining tDCS and PNE in those with chronic low back pain (CLBP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Six participants experiencing CLBP completed the study. Assessments for pain catastrophizing, kinesiophobia, pressure pain thresholds (PPT), pain intensity, cognitive function, and resting state and task fMRI were collected before and after the combined tDCS and PNE intervention. Each participant received five 20\u2010min sessions of 2.0\u00a0mA tDCS targeting the left dorsolateral prefrontal cortex (DLPFC), followed by a 20\u2010min PNE session.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The participants had a 58.9% reduction in pain catastrophizing, a 25.9% reduction in kinesiophobia, and an 18.8% improvement in cognitive function (i.e., reduced attentional interference). The MRI results indicated increased gray matter volume within the left DLPFC. Additionally, larger reductions in DLPFC activity at rest were associated with larger reductions in kinesiophobia. Increased modularity within networks responsible for cognitive control and executive functions was evident following the intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Our clinical and fMRI outcomes shed light on the clinical potential of combining tDCS and PNE, as well as the mechanisms substantiating their effects. We speculate that tDCS alters brain activity and structure, amplifies the effects of PNE, and promotes positive changes in the cognitive\u2010evaluative and sensory\u2010discriminative pain domains investigated. A randomized controlled trial is warranted to determine the effects of tDCS combined with PNE compared with tDCS or PNE alone.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/brb3.70543","type":"journal-article","created":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T08:35:12Z","timestamp":1746693312000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Effect of Combining Transcranial Direct Current Stimulation and Pain Neuroscience Education in Patients With Chronic Low Back Pain and High Pain Catastrophizing: An Exploratory Clinical, Cognitive, and fMRI Study"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7654-4301","authenticated-orcid":false,"given":"Cory","family":"Alcon","sequence":"first","affiliation":[{"name":"Department of Physical Therapy High Point University  High Point North Carolina USA"},{"name":"School of Physical Therapy Texas Woman's University\u2013Dallas  Dallas Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Margerison","sequence":"additional","affiliation":[{"name":"Department of Neural and Pain Sciences University of Maryland School of Dentistry  Baltimore Maryland USA"},{"name":"Center to Advance Chronic Pain Research University of Maryland Baltimore  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haley","family":"Kirse","sequence":"additional","affiliation":[{"name":"Laboratory for Complex Brain Networks, Wake Forest School of Medicine  Winston\u2010Salem North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Zoch","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy High Point University  High Point North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8871-9658","authenticated-orcid":false,"given":"Paul","family":"Laurienti","sequence":"additional","affiliation":[{"name":"Laboratory for Complex Brain Networks, Wake Forest School of Medicine  Winston\u2010Salem North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Seminowicz","sequence":"additional","affiliation":[{"name":"Department of Neural and Pain Sciences University of Maryland School of Dentistry  Baltimore Maryland USA"},{"name":"Center to Advance Chronic Pain Research University of Maryland Baltimore  Baltimore Maryland USA"},{"name":"Department of Medical Biophysics Schulich School of Medicine &amp; 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