Kregel Jeroen, Coppieters Iris, DePauw Robby, Malfliet Anneleen, Danneels Lieven, Nijs Jo, Cagnie Barbara, Meeus Mira
Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University; Department of Physiotherapy, Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel.
Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University.
Pain Physician. 2017 Mar;20(3):139-154.
Chronic musculoskeletal pain is characterized by maladaptive central neuroplastic changes. Many observational studies have demonstrated that chronic pain states are associated with brain alterations regarding structure and/or function. Rehabilitation of patients with chronic musculoskeletal pain may include cognitive, exercise, or multimodal therapies.
The current review aims to provide a constructive overview of the existing literature reporting neural correlates, based on brain magnetic resonance imaging (MRI) techniques, following conservative treatment in chronic musculoskeletal pain patients.
Systematic review of the literature.
University medical centers in Belgium.
The current review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Literature was searched from 3 databases and screened for eligibility. Methodological quality across studies was assessed with Cochrane Collaboration's tool for assessing risk of bias and quality of evidence was determined applying the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach.
A total of 9 eligible studies were identified with a predominant high risk of bias. Cognitive behavioral therapy induced several structural and functional changes predominantly in prefrontal cortical regions and a shift from affective to sensory-discriminative brain activity after behavioral extinction training. Multidisciplinary treatment in pediatric complex regional pain syndrome facilitated normalization of functional connectivity of resting-state networks and the amygdala, and increased gray matter in prefrontal and specific subcortical areas. Exercise therapy led to specific for resting-state functional connectivity and a trend towards pressure-induced brain activity changes.
A very small number of studies was available, which furthermore exhibited small study samples. Moreover, only 2 of the included studies were randomized controlled trials.
It is likely that conservative treatments may induce mainly functional and structural brain changes in prefrontal regions in patients with chronic musculoskeletal pain. Due to the relatively high risk of bias across the included studies, future studies with randomized designs are needed to confirm the current findings. In addition, more research evaluating the treatment-induced effects on white matter and whole-brain network dynamics are warranted.Key words: Chronic pain, musculoskeletal pain, MRI, functional MRI, therapy, rehabilitation, cognitive behavioral therapy, exercise therapy.
慢性肌肉骨骼疼痛的特征是适应性不良的中枢神经可塑性变化。许多观察性研究表明，慢性疼痛状态与大脑结构和/或功能的改变有关。慢性肌肉骨骼疼痛患者的康复治疗可能包括认知、运动或多模式疗法。
本综述旨在基于脑磁共振成像（MRI）技术，对慢性肌肉骨骼疼痛患者保守治疗后报告神经相关性的现有文献进行建设性概述。
文献系统综述。
比利时的大学医学中心。
本综述按照系统评价和Meta分析的首选报告项目（PRISMA）声明进行。从3个数据库中检索文献并筛选其是否符合纳入标准。使用Cochrane协作网的偏倚风险评估工具评估各研究的方法学质量，并采用推荐分级、评估、制定与评价（GRADE）方法确定证据质量。
共确定了9项符合纳入标准的研究，这些研究大多存在较高的偏倚风险。认知行为疗法主要在前额叶皮质区域引起了一些结构和功能变化，并且在行为消退训练后，大脑活动从情感性向感觉辨别性转变。小儿复杂性区域疼痛综合征的多学科治疗促进了静息态网络和杏仁核功能连接的正常化，并增加了前额叶和特定皮质下区域的灰质。运动疗法导致静息态功能连接出现特异性变化，并呈现出压力诱导脑活动变化的趋势。
可用研究数量非常少，而且研究样本量也小。此外，纳入的研究中只有2项是随机对照试验。
保守治疗可能主要在慢性肌肉骨骼疼痛患者的前额叶区域引起大脑功能和结构的变化。由于纳入研究中存在相对较高的偏倚风险，需要未来采用随机设计的研究来证实当前的发现。此外，有必要开展更多研究来评估治疗对白质和全脑网络动力学的影响。关键词：慢性疼痛；肌肉骨骼疼痛；MRI；功能MRI；治疗；康复；认知行为疗法；运动疗法
