Elgueta-Cancino Edith, Schabrun Siobhan, Hodges Paul
Centre of Clinical Excellence Research in Spinal Pain Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland.
Brain Rehabilitation and Neuroplasticity Unit (BRAiN-u), Western Sydney University, Sydney, NSW, Australia.
Clin J Pain. 2018 Mar;34(3):207-216. doi: 10.1097/AJP.0000000000000535.
AIM/BACKGROUND: Primary motor cortex (M1) organization differs between individuals with and without chronic low back pain (CLBP), in parallel with motor and sensory impairments. This study investigated whether movement behaviour and tactile/pain sensation are related to M1 organisation in CLBP.
Transcranial magnetic stimulation (TMS) was used to map the M1 representation of the erector spinae and multifidus muscles in 20 participants with and without CLBP. Cortical organisation was quantified by: map volume; center of gravity (CoG); number of peaks; and primary and secondary peak location. Movement behaviour was assessed as the ability to dissociate lumbar from thorax motion and sensory function as two-point discrimination, pressure pain thresholds, and pain intensity (visual analogue scale).
People with CLBP showed more anterior location of the CoG than controls. Map peaks were more numerous in CLBP participants who performed the movement task good than those with poor performance. In CLBP, smaller map volume correlated with greater pain during the movement task. Movement behaviour was not linearly correlated with M1 features.
This study confirms that M1 maps differ between people with and without CLBP, but these changes are variable within the CLBP group and are not related to motor and sensory features in a simple manner.
目的/背景:原发性运动皮层(M1)的组织在慢性下腰痛(CLBP)患者和非CLBP患者之间存在差异,同时伴有运动和感觉障碍。本研究调查了CLBP患者的运动行为和触觉/痛觉是否与M1组织有关。
采用经颅磁刺激(TMS)对20名有或无CLBP的参与者竖脊肌和多裂肌的M1代表区进行映射。通过以下指标对皮质组织进行量化:映射体积;重心(CoG);峰值数量;以及主要和次要峰值位置。将运动行为评估为区分腰椎和胸部运动的能力,将感觉功能评估为两点辨别、压痛阈值和疼痛强度(视觉模拟量表)。
CLBP患者的CoG位置比对照组更靠前。在完成运动任务表现良好的CLBP参与者中,映射峰值比表现较差的参与者更多。在CLBP患者中,较小的映射体积与运动任务期间更强烈的疼痛相关。运动行为与M1特征无线性相关性。
本研究证实,有或无CLBP的人之间M1映射不同,但这些变化在CLBP组内是可变的,并且与运动和感觉特征没有简单的关联。