The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, Brisbane, Qld, Australia.
Université Laval, Cirris, CIUSSS-Capitale Nationale, Quebec City, Qc, Canada.
PLoS One. 2023 Jun 14;18(6):e0286786. doi: 10.1371/journal.pone.0286786. eCollection 2023.
Individuals with chronic low back pain (CLBP) move their spine differently. Changes in brain motor areas have been observed and suggested as a mechanism underlying spine movement alteration. Nociceptive withdrawal reflex (NWR) might be used to test spinal networks involved in trunk protection and to highlight reorganization. This study aimed to determine whether the organization and excitability of the trunk NWR are modified in CLBP. We hypothesized that individuals with CLBP would have modified NWR patterns and lower NWR thresholds. Noxious electrical stimuli were delivered over S1, L3 and T12, and the 8th Rib to elicit NWR in 12 individuals with and 13 individuals without CLBP. EMG amplitude and occurrence of lumbar multifidus (LM), thoracic erector spinae, rectus abdominus, obliquus internus and obliquus externus motor responses were recorded using surface electrodes. Two different patterns of responses to noxious stimuli were identified in CLBP compared to controls: (i) abdominal muscle NWR responses were generally more frequent following 8th rib stimulation and (ii) occurrence of erector spinae NWR was less frequent. In addition, we observed a subgroup of participants with very high NWR threshold in conjunction with the larger abdominal muscle responses. These results suggest sensitization of NWR is not present in all individuals with CLBP, and a modified organization in the spinal networks controlling the trunk muscles that might explain some changes in spine motor control observed in CLBP.
患有慢性下背痛 (CLBP) 的个体的脊柱活动方式不同。已经观察到大脑运动区域的变化,并将其作为脊柱运动改变的机制之一。伤害性撤回反射 (NWR) 可用于测试涉及躯干保护的脊柱网络,并突出其重组。本研究旨在确定 CLBP 患者的躯干 NWR 的组织和兴奋性是否发生改变。我们假设 CLBP 患者的 NWR 模式会发生改变,且 NWR 阈值会降低。通过 S1、L3 和 T12 以及第 8 肋骨施加有害电刺激,以在 12 名患有和 13 名无 CLBP 的个体中诱发 NWR。使用表面电极记录肌电图幅度和竖脊肌 (LM)、胸髂肋肌、腹直肌、内斜肌和外斜肌运动反应的发生情况。与对照组相比,CLBP 患者对有害刺激的反应有两种不同的模式:(i) 肋骨刺激后,腹部肌肉 NWR 反应通常更为频繁;(ii) 竖脊肌 NWR 的发生频率较低。此外,我们还观察到一个具有非常高 NWR 阈值的亚组参与者,同时伴有更大的腹部肌肉反应。这些结果表明,并非所有 CLBP 患者都存在 NWR 敏化,控制躯干肌肉的脊髓网络的组织发生改变,这可能解释了 CLBP 中观察到的脊柱运动控制的一些变化。