Abstract
Background: Spinal manipulative therapy (SMT) helps to reduce chronic low back pain (cLBP). However, the underlying mechanism of pain relief and the neurological response to SMT remains unclear. We utilized brain functional magnetic resonance imaging (fMRI) upon the application of a real-time spot pressure mechanical stimulus to assess the effects of SMT on patients with cLBP.Methods: Patients with cLBP (Group 1, n = 14) and age-matched healthy controls without cLBP (Group 2, n = 20) were prospectively enrolled. Brain fMRI was performed for Group 1 at three time points: before SMT (TP1), after the first SMT session (TP2), and after the sixth SMT session (TP3). The healthy controls (Group 2) did not receive SMT and underwent only one fMRI scan. During fMRI scanning, a real-time spot pressure mechanical stimulus was applied to the low back area of all participants. Participants in Group 1 completed clinical questionnaires assessing pain and quality of life using a visual analog scale (VAS) and the Chinese Short Form Oswestry Disability Index (C-SFODI), respectively.Results: Before SMT (TP1), there were no significant differences in brain activity between Group 1 and Group 2. After the first SMT session (TP2), Group 1 showed significantly greater brain activity in the right parahippocampal gyrus, right dorsolateral prefrontal cortex, and left precuneus compared to Group 2 (P < 0.05). After the sixth SMT session (TP3), Group 1 showed significantly greater brain activity in the posterior cingulate gyrus and right inferior frontal gyrus compared to Group 2 (P < 0.05). After both the first and sixth SMT sessions (TP2 and TP3), Group 1 had significantly lower VAS pain scores and C-SFODI scores than at TP1 (P < 0.001).Conclusion: We observed alterations in brain activity in regions of the default mode network in patients with cLBP after SMT. These findings suggest the potential utility of the default mode network as a neuroimaging biomarker for pain management in patients with cLBP.Clinical Trial Registration: Chinese Clinical Trial Registry, identifier ChiCTR1800015620.
Highlights
Chronic low back pain is one of the most common ailments, affecting ∼13 in 100 people at some point in their lives, and contributes to great socioeconomic costs around the world (Shmagel et al, 2016)
One patient had a metatarsal fracture after the first Spinal manipulative therapy (SMT) session and voluntarily withdrew from the study. Another patient with Chronic low back pain (cLBP) did not return for the sixth SMT session because his pain subsided
At baseline (TP1, before SMT), there were no significant differences in brain activity between Group 1 and Group 2 (P > 0.05)
Summary
Chronic low back pain (cLBP) is one of the most common ailments, affecting ∼13 in 100 people at some point in their lives, and contributes to great socioeconomic costs around the world (Shmagel et al, 2016). Spinal manipulative therapy (SMT), one of several complementary nonsurgical treatment methods for cLBP (Bervoets et al, 2015; Lee et al, 2017), is performed by trained practitioners who apply a controlled force to the spine using their hands or a specialized device for pain relief. SMT helps to reduce pain and improves the physical functioning of patients with cLBP (Bronfort et al, 2010; Kong et al, 2012). Spinal manipulative therapy (SMT) helps to reduce chronic low back pain (cLBP). We utilized brain functional magnetic resonance imaging (fMRI) upon the application of a real-time spot pressure mechanical stimulus to assess the effects of SMT on patients with cLBP
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