运动控制训练改善慢性非特异性腰痛的fMRI研究

关键词：慢性非特异性腰痛  运动控制训练  静息态功能磁共振  低频振幅  枕中回

Keywords:non-specific chronic low back pain  motor control exercise  resting-state functional magnetic resonance imaging  amplitude of low-frequency fluctuations  middle occipital gyrus

摘要：

      摘要 目的：探讨运动控制训练（MCE）对慢性非特异性腰痛（NSCLBP）患者静息状态下局部神经元自发性神经活动变化的影响及MCE干前预后静息状态下局部自发性神经元活动变化与临床症状改变之间的关系。 方法：21例NSCLBP患者完成为期6周MCE训练（每周3次，每次30min）。治疗前后采用视觉模拟评分法（VAS）、简化McGill疼痛问卷（SFMPQ）、Oswestry功能障碍指数（ODI）以及疼痛灾难化量表（PCS）对患者进行评估，并进行静息态fMRI扫描。采用配对t检验比较治疗前后VAS评分、SFMPQ评分、ODI评分、PCS评分和低频振幅值(ALFF)改变。分析MCE干预前后疼痛程度、功能障碍、疼痛灾难化程度等临床症状改变与差异脑区ALFF值变化关系。 结果：治疗后NSCLBP患者VAS评分由5.74±1.37降低至1.71±1.03，SFMPQ评分由8.43±4.25降低至2.00±1.61，ODI评分由15.53±6.79降低至6.87±4.01，PCS评分由10.43±7.49降低至1.62±2.29，差异均具有显著性意义（P<0.05）。治疗后NSCLBP患者双侧枕中回ALLF值增高（体素水平P<0.001，团簇水平FWE矫正P<0.05）。左侧枕中回ALLF值改变与PCS量表的无助感评分改变呈显著负相关（r=﹣0.486，P=0.025），与疼痛灾难化程度改变呈显著负相关（r=﹣0.568，P=0.007）。 结论：MCE可有效改善NSCLBP患者疼痛程度、功能障碍、疼痛灾难化程度。MCE改善疼痛灾难化程度的作用可能与其调节静息状态下左侧枕中回局部神经元自发性神经活动相关。

Abstract:

      Abstract Objective： To explore the motor control exercise（MCE） related intrinsic neural changes in patients with non-specific chronic low back pain（NSCLBP） and the associations between the MCE-related intrinsic neural changes and the alterations of clinical symptoms with the resting-state functional magnetic resonance imaging(rs-fMRI). Method： Twenty-one patients completed a 6-week MCE program (3 treatment sessions per week， 30 minutes per session). Before and after the MCE program， all the subjects underwent assessments of visual analogue scale (VAS)， short-form McGill pain questionnaire (SFMPQ)， Oswestry disability index (ODI)， pain catastrophizing scale (PCS)， and rs-fMRI scans. The pre-post treatment alterations of scores of VAS， SFMPQ， ODI， PCS， and amplitude of low-frequency fluctuation (ALFF) were evaluated by paired-t test. The associations between the alterations of pain intensity， the degree of disability and pain catastrophizing， and changes of ALLF value of areas with a significant difference were analyzed. Result： After treatment， the scores of VAS were reduced from 5.74±1.37 to 1.71±1.03，the scores of SFMPQ were reduced from 8.43±4.25 to 2.00±1.61，the scores of ODI were reduced from 15.53±6.79 to 6.87±4.01，the scores of PCS were reduced from 10.43±7.49 to 1.62±2.29，all those changes were statistically significant(P<0.05).Significant increase in ALFF was observed in the bilateral middle occipital gyrus(two-tailed， voxel-level uncorrected P<0.001， cluster-level FWE corrected P<0.05). The correlation analysis revealed that the pre-post treatment change of ALFF value in the left middle occipital gyrus was significantly negatively related to the changes of helplessness subscale of PCS(r=﹣0.486，P=0.025) and the total scores of PCS(r=﹣0.568，P=0.007). Conclusion： These findings demonstrated that MCE can effectively alleviate the pain intensity， and reduce the level of disability and pain catastrophizing. MCE’s effects on reducing the pain catastrophizing may be related to the effects of modifying the intrinsic neural activity of the middle occipital gyrus.