Identifying Pain Modulating Brain Mechanisms After Qigong Practice For Pain Reduction In Adults With Chronic Low Back Pain: A Proof Of Concept Study

Abstract

Research Objectives Twenty million Americans suffer from chronic low back pain (cLBP). Due to the limited success of medications, mind and body approaches that incorporate mindful movement have potential for cLBP because movement is often impaired. Qigong is accessible due to its gentle movements and dual focus on breathing and body awareness. Our previous research and others found that two brain areas (parietal operculum, insula) are important brain areas for body awareness and pain perception. We determined the proof of concept in demonstrating pain-related brain function changes after Qigong or exercises concurrent with changes in pain and associated outcomes. Design Randomized pilot clinical trial. Setting University of Minnesota with remote intervention. Participants Our goal is to enroll 32 participants. To date 12 participants (2 men, 10 women, average age 45.5 years) were randomized into the Qigong practice (n=6) or P.Volve (n=6) group and completed the study. Interventions The Qigong group practiced the “5 Elements Qigong Healing”. The active comparison group received low-impact exercises designed by P.Volve, which focuses on core strengthening and stabilization. Both groups received a video link to practice at home with 40min/session videos, 3x/week for 12 weeks. Main Outcome Measures We performed 3 fMRI tasks: mental focus on low back pain; an imagined Qigong movement; shape discrimination (MRI-compatible robot). Our patient self-reported measures were pain intensity levels/week; functional tasks, Modified Roland-Morris disability questionnaire, 4 body awareness scales, proprioceptive acuity, core strength, and balance. All assessments were performed before and after the 12-week interventions. Results In the MRI, parietal operculum activation reduced during the Qigong task (Qigong group) and during the mental focus on low back pain task (P.Volve group). These brain function changes were seen alongside within-group improvement in our self-reported measures (effect-sizes d=1.1-2.0), and in strength and balance (d=0.76-1.68). Conclusions Our observations so far support our proof of concept and presents the first step to understanding the brain mechanisms of alternative treatments that improve dysfunctional pain processing in the brain to reduce LBP. Author(s) Disclosures No conflict of interest. Twenty million Americans suffer from chronic low back pain (cLBP). Due to the limited success of medications, mind and body approaches that incorporate mindful movement have potential for cLBP because movement is often impaired. Qigong is accessible due to its gentle movements and dual focus on breathing and body awareness. Our previous research and others found that two brain areas (parietal operculum, insula) are important brain areas for body awareness and pain perception. We determined the proof of concept in demonstrating pain-related brain function changes after Qigong or exercises concurrent with changes in pain and associated outcomes. Randomized pilot clinical trial. University of Minnesota with remote intervention. Our goal is to enroll 32 participants. To date 12 participants (2 men, 10 women, average age 45.5 years) were randomized into the Qigong practice (n=6) or P.Volve (n=6) group and completed the study. The Qigong group practiced the “5 Elements Qigong Healing”. The active comparison group received low-impact exercises designed by P.Volve, which focuses on core strengthening and stabilization. Both groups received a video link to practice at home with 40min/session videos, 3x/week for 12 weeks. We performed 3 fMRI tasks: mental focus on low back pain; an imagined Qigong movement; shape discrimination (MRI-compatible robot). Our patient self-reported measures were pain intensity levels/week; functional tasks, Modified Roland-Morris disability questionnaire, 4 body awareness scales, proprioceptive acuity, core strength, and balance. All assessments were performed before and after the 12-week interventions. In the MRI, parietal operculum activation reduced during the Qigong task (Qigong group) and during the mental focus on low back pain task (P.Volve group). These brain function changes were seen alongside within-group improvement in our self-reported measures (effect-sizes d=1.1-2.0), and in strength and balance (d=0.76-1.68). Our observations so far support our proof of concept and presents the first step to understanding the brain mechanisms of alternative treatments that improve dysfunctional pain processing in the brain to reduce LBP.