Abstract
Chronic low back pain (chronic LBP) is both debilitating for patients but also a major burden on the health care system. Previous studies reported various maladaptive structural and functional changes among chronic LBP patients on spine- and supraspinal levels including behavioral alterations. However, evidence for cortical reorganization in the sensorimotor system of chronic LBP patients is scarce. Motor Imagery (MI) is suitable for investigating the cortical sensorimotor network as it serves as a proxy for motor execution. Our aim was to investigate differential MI-driven cortical processing in chronic LBP compared to healthy controls (HC) by means of functional magnetic resonance imaging (fMRI). Twenty-nine subjects (15 chronic LBP patients, 14 HC) were included in the current study. MI stimuli consisted of randomly presented video clips showing every-day activities involving different whole-body movements as well as walking on even ground and walking downstairs and upstairs. Guided by the video clips, subjects had to perform MI of these activities, subsequently rating the vividness of their MI performance. Brain activity analysis revealed that chronic LBP patients exhibited significantly reduced activity compared to HC subjects in MI-related brain regions, namely the left supplementary motor area and right superior temporal sulcus. Furthermore, psycho-physiological-interaction analysis yielded significantly enhanced functional connectivity (FC) between various MI-associated brain regions in chronic LBP patients indicating diffuse and non-specific changes in FC. Current results demonstrate initial findings about differences in MI-driven cortical processing in chronic LBP pointing towards reorganization processes in the sensorimotor network.
Highlights
Low back pain (LBP) is a major health problem with a lifetime prevalence of 85% [1]
Evidence on cortical sensorimotor reorganization in LBP patients investigated by neuroimaging is sparse. This is especially true for functional magnetic resonance imaging measures, as it is challenging to investigate brain activity related to whole-body movements in an MR scanner due to the fact that fMRI data quality is strongly sensitive to subject motion
The repeated measure ANOVA for the ratings of the Motor Imagery (MI) performance revealed a main effect of condition (“Activities” vs. “Walking”, F=10.153, p0.8)
Summary
Low back pain (LBP) is a major health problem with a lifetime prevalence of 85% [1]. While the majority of acute LBP patients recover within weeks, a small minority becomes chronic (pain lasts > 6 months). Evidence on cortical sensorimotor reorganization in LBP patients investigated by neuroimaging is sparse This is especially true for functional magnetic resonance imaging (fMRI) measures, as it is challenging to investigate brain activity related to whole-body movements in an MR scanner due to the fact that fMRI data quality is strongly sensitive to subject motion. MI has been studied extensively in healthy subjects [25,27,28,29], especially in motor learning and is used to improve performance in sports [30,31] It may play an important role in neuro-rehabilitation [32,33,34], evidence for cortical functioning of MI in chronic LBP patients is lacking
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