National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA.
College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China; Traditional Chinese Medicine Rehabilitation Research Center of State Administration of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China.
Br J Anaesth. 2019 Oct;123(4):506-518. doi: 10.1016/j.bja.2019.06.017. Epub 2019 Aug 5.
Knee osteoarthritis is a prevalent disorder with unsatisfactory treatment options. Both physical and mindful exercises may be able to relieve its pain symptoms. We compared the modulatory effects of different exercise modalities on the periaqueductal grey (PAG) and ventral tegmental area (VTA), which play important roles in descending opioidergic pathways and reward/motivation systems in patients with knee osteoarthritis.
We recruited and randomised 140 patients into Tai Chi, Baduanjin, stationary cycling, and health education control groups for 12 weeks. Knee injury and Osteoarthritis Outcome Score (KOOS), functional and structural MRI, and blood biomarkers were measured at the beginning and end of the experiment. We used the PAG and VTA as seeds in resting-state functional connectivity (rsFC) analysis.
Compared with the control group: (i) all exercises significantly increased KOOS pain sub-scores (pain reduction) and serum programmed death 1 (PD-1) concentrations; (ii) all exercises decreased right PAG rsFC with the medial orbital prefrontal cortex, and the decreased rsFC was associated with improvements in knee pain; and (iii) grey matter volume in the medial orbital prefrontal cortex was significantly increased in all exercise groups. There was also significantly decreased rsFC between the left VTA and the medial orbital prefrontal cortex in the Tai Chi and Baduanjin groups.
Exercise can simultaneously modulate the rsFC of the descending opioidergic pathway and reward/motivation system and blood inflammation markers. Elucidating the shared and unique mechanisms of different exercise modalities may facilitate the development of exercise-based interventions for chronic pain.
ChiCTR-IOR-16009308.
膝骨关节炎是一种普遍存在的疾病，治疗选择不理想。身体和正念运动都可能缓解其疼痛症状。我们比较了不同运动方式对膝骨关节炎患者下行阿片通路和奖赏/动机系统中重要部位——导水管周围灰质（PAG）和腹侧被盖区（VTA）的调节作用。
我们招募了 140 名患者，并将他们随机分为太极拳、八段锦、固定自行车和健康教育对照组，进行 12 周的治疗。在实验开始和结束时测量膝关节损伤和骨关节炎结局评分（KOOS）、功能和结构 MRI 以及血液生物标志物。我们使用 PAG 和 VTA 作为静息态功能连接（rsFC）分析的种子。
与对照组相比：（i）所有运动都显著提高了 KOOS 疼痛子评分（疼痛减轻）和血清程序性死亡 1（PD-1）浓度；（ii）所有运动都降低了右侧 PAG 与内侧眶额皮质的 rsFC，并且 rsFC 的降低与膝关节疼痛的改善相关；（iii）所有运动组的内侧眶额皮质灰质体积都显著增加。在太极拳和八段锦组中，左侧 VTA 与内侧眶额皮质之间的 rsFC 也显著降低。
运动可以同时调节下行阿片通路和奖赏/动机系统以及血液炎症标志物的 rsFC。阐明不同运动方式的共同和独特机制可能有助于开发基于运动的慢性疼痛干预措施。
ChiCTR-IOR-16009308。
