Motor Control Exercise Modulates the Neural Plasticity of the Default Mode Network in Patients with Chronic Low Back Pain
Chuhuai Wang
Pain Physician Journal January 20, 2024 DOI: 10.36076/ppj.2024.27.e55 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 58 |
| Population | Patients with nonspecific chronic low back pain |
| Interventions | Motor control exercise Manual therapy |
| Measures | Visual analog scale, ultrasound imaging of transversus abdominis activation, resting-state functional magnetic resonance imaging (fractional amplitude of low-frequency fluctuation, effective connectivity), questionnaire assessments |
| Topics | Default mode network Neuroplasticity |
| Key findings | Motor control exercise and manual therapy both reduced pain intensity, pain catastrophizing, and pain-related disability, but motor control exercise led to greater improvement in pain-related disability and right transversus abdominis activation. Motor control exercise also increased precuneus activity and decreased effective connectivity from the precuneus to the left dorsolateral prefrontal cortex; these connectivity changes correlated with changes in visual analog scale scores (r = 0.765) and right transversus abdominis activation (r = 0.481). The authors conclude that motor control exercise may alleviate chronic low back pain by modifying information transmission from the default mode network to the left frontoparietal network. |
Abstract
Background: Motor control exercise (MCE) effectively alleviates nonspecific chronic low back pain (CLBP), but the neural mechanisms underlying this phenomenon are poorly understood.
Objective: To study MCE’s neural mechanisms in patients with CLBP by resting-state functional magnetic resonance imaging (rs-fMRI). STUDY
Design: A prospective, single-blind, randomized, controlled trial.
Setting: Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University.
Methods: 58 patients were randomly assigned to either the MCE or the Manual Therapy (MT) group. Before and after treatment, all the patients underwent ultrasound imaging to measure transversus abdominis (TrA) activation, rs-fMRI scans and questionnaire assessments. We analyzed the activation and connectivity of the bilateral precuneus based on the fractional amplitude of low-frequency fluctuation (fALFF) and effective connectivity (EC) analyses. Further, we determined the association between imaging and clinical measures.
Results: Pain intensity, pain catastrophizing, and pain-related disability were alleviated significantly in both groups post-treatment. However, the MCE group showed a greater reduction in pain-related disability and a better improvement in activation of the right TrA than the MT group. After MCE, patients showed an increase in regional fALFF values in the key node of the default mode network (bilateral precuneus) and decreased EC from the bilateral precuneus to the key node of the frontoparietal network (the left dorsolateral prefrontal cortex (DLPFC)). The pre-to-post-treatment change in the EC from bilateral precuneus into the left DLPFC was significantly correlated with the pre-to-post-treatment change in visual analog scale scores and activation of the right TrA in the MCE group (r = 0.765, P < 0.001 and r = 0.481 and P = 0.043 respectively).
Limitations: The present study showes the correlation between the alteration of brain functions and CLBP-related symptoms, which does not reveal the causal effect between them. Further, this study does not estimate the long-term efficacy of MCE on brain function, and the sample size was not calculated based on fMRI data.
Conclusion: These findings demonstrate that MCE may alleviate CLBP symptoms in patients by modifying information transmission from the default mode network to the left frontoparietal network. KEY WORDS: Chronic low back pain, motor control exercise, resting-state functional magnetic resonance imaging, granger causality analysis, precuneus, default mode network, dorsolateral prefrontal cortex, frontoparietal network
Comparable studies
Other randomized controlled trials on default mode network, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Neural correlates of the psychedelic state as determined by fMRI studies with psilocybin Healthy volunteers | 2012 | Within-subjects, placebo-controlled, task-free fMRI study | n = 30 |
| The effects of psilocybin and MDMA on between-network resting state functional connectivity in healthy volunteers | 2014 | Placebo-controlled study | |
| Ketamine Decreases Resting State Functional Network Connectivity in Healthy Subjects: Implications for Antidepressant Drug Action Healthy subjects | 2012 | Randomized, placebo-controlled, double-blind, crossover rsfMRI challenge | |
| Antidepressants Normalize the Default Mode Network in Patients With Dysthymia Subjects with dysthymic disorder and healthy control participants aged 18 to 53 years | 2013 | Randomized controlled trial | n = 41 |
| Functional Connectivity Measures After Psilocybin Inform a Novel Hypothesis of Early Psychosis Healthy volunteers | 2012 | Within-subject, placebo-controlled experimental study | n = 15 |