Modulating Gamma Oscillations in the Anterior Cingulate Cortex with Intermittent Theta Burst Stimulation: Implications for Chronic Non-Specific Low Back Pain

Hui Jiang,1,* Qiaohua Wang,1,* Zhengfei Ye,2 Yi Ding3 1Huangshi Hospital of Traditional Chinese Medicine, Huangshi, Hubei, People’s Republic of China; 2Department of Rehabilitation, Huangshi Hospital of Traditional Chinese Medicine, Huangshi, Hubei, People’s Republic of China; 3Huangshi Central Hospital, Huangshi, Hubei, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhengfei Ye; Yi Ding, Email [email protected]; [email protected]: Chronic nonspecific low back pain (CNSLBP), a debilitating condition associated with abnormal anterior cingulate cortex (ACC) activity and central sensitization, may be addressed through intermittent theta-burst stimulation (iTBS), a non-invasive neuromodulation technique. iTBS is designed to restore the ACC’s excitatory/inhibitory balance by suppressing abnormal gamma oscillations and enhancing synaptic plasticity. Clinical evidence shows that iTBS can reduce ACC gamma power, strengthen corticostriatal circuit connectivity, and provide short-term pain relief, although efficacy varies with protocol, pain subtype, and individual differences. In conclusion, iTBS represents a promising approach for managing CNSLBP by modulating neuroplasticity. Future efforts should focus on optimizing stimulation parameters, integrating multimodal data for personalized treatment, and validating long-term benefits through large-scale trials to shift the therapeutic paradigm towards remodeling maladaptive neural pathways.Keywords: low back pain, anterior cingulate cortex, nerve oscillations, gamma oscillations, intermittent theta burst stimulation, chronic pain