IMMEDIATE CHANGES AFTER MANUAL THERAPY IN RESTING-STATE FUNCTIONAL CONNECTIVITY AS MEASURED BY FUNCTIONAL MAGNETIC RESONANCE IMAGING IN PARTICIPANTS WITH INDUCED LOW BACK PAIN
IMMEDIATE CHANGES AFTER MANUAL THERAPY IN RESTING-STATE FUNCTIONAL CONNECTIVITY AS MEASURED BY FUNCTIONAL MAGNETIC RESONANCE IMAGING IN PARTICIPANTS WITH INDUCED LOW BACK PAIN
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DOI：
10.1016/j.jmpt.2014.09.001
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发表时间：
2014-11-01
影响因子：
1.3
通讯作者：
Bishop, Mark D.
中科院分区：
文献类型：
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作者：
Gay, Charles W.;Robinson, Michael E.;Bishop, Mark D.
目的：本研究的目的是使用功能性磁共振成像来研究3种不同类型的手动治疗（MT）后处理和调节疼痛体验的脑区域之间的功能连接（FC）的即时变化，并确定实验诱导的肌痛的减少以及局部和远程压力疼痛敏感性的变化。（17名男性;平均年龄+/- SD，21.6 +/- 4.2岁），他们完成了一项运动损伤协议，以诱导腰痛，被随机分为3组：脊椎推拿（n = 6），脊柱松动（n = 8），或治疗触摸（n = 10）。主要结局是通过功能性磁共振成像测量以下脑区之间的FC即时变化：体感皮层、次级体感皮层、丘脑、前扣带皮层和后扣带皮层、前扣带皮层和后扣带皮层以及导水管周围灰质。次要结果是疼痛强度的即时变化，用101分数字评定量表测量，疼痛敏感性，用手持式测力计测量。重复测量方差分析模型和相关性分析进行了检查治疗效果和人内变化之间的关系，跨outcome measurements.Results：FC的变化被发现之间的几个大脑区域是共同的所有3 MT干预措施。在几个脑区之间也观察到FC的治疗依赖性变化。所有干预后疼痛强度均有所改善（P <0.05），两组之间无差异（P > 0.05）。有没有观察到的变化，疼痛敏感性，或之间的关联的主要和次要的结果measurement.Conclusion：这些结果表明，MT（脊椎按摩脊柱操作，脊柱动员，治疗触摸）有一个直接的影响FC之间的大脑区域参与处理和调制的疼痛体验。这表明MT后的神经生理学变化可能是疼痛缓解的潜在机制。
Objective: The purposes of this study were to use functional magnetic resonance imaging to investigate the immediate changes in functional connectivity (FC) between brain regions that process and modulate the pain experience after 3 different types of manual therapies (MT) and to identify reductions in experimentally induced myalgia and changes in local and remote pressure pain sensitivity.Methods: Twenty-four participants (17 men; mean age +/- SD, 21.6 +/- 4.2 years) who completed an exercise-injury protocol to induce low back pain were randomized into 3 groups: chiropractic spinal manipulation (n = 6), spinal mobilization (n = 8), or therapeutic touch (n = 10). The primary outcome was the immediate change in FC as measured on functional magnetic resonance imaging between the following brain regions: somatosensory cortex, secondary somatosensory cortex, thalamus, anterior and posterior cingulate cortices, anterior and poster insula, and periaqueductal gray. Secondary outcomes were immediate changes in pain intensity, measured with a 101-point numeric rating scale, and pain sensitivity, measured with a handheld dynamometer. Repeated-measures analysis of variance models and correlation analyses were conducted to examine treatment effects and the relationship between within-person changes across outcome measures.Results: Changes in FC were found between several brain regions that were common to all 3 MT interventions. Treatment-dependent changes in FC were also observed between several brain regions. Improvement was seen in pain intensity after all interventions (P < .05) with no difference between groups (P > .05). There were no observed changes in pain sensitivity, or an association between primary and secondary outcome measures.Conclusion: These results suggest that MTs (chiropractic spinal manipulation, spinal mobilization, and therapeutic touch) have an immediate effect on the FC between brain regions involved in processing and modulating the pain experience. This suggests that neurophysiologic changes after MT may be an underlying mechanism of pain relief.