Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany.
Physiother Res Int. 2024 Jul;29(3):e2102. doi: 10.1002/pri.2102.
Transcranial Magnetic Stimulation (TMS) studies examining exercise-induced neuroplasticity in pain populations have produced contradictory findings. We conducted a systematic review to explore how exercise impacts cortical excitability in pain populations using TMS metrics. This review aims to summarize the effect sizes and to understand their sources of heterogeneity.
We searched multiple databases from inception to December 2022. We included randomized controlled trials (RCTs) with any type of pain population, including acute and chronic pain; exercise interventions were compared to sham exercise or other active interventions. The primary outcomes were TMS metrics, and pain intensity was the secondary outcome. Risk of bias assessment was conducted using the Cochrane tool.
This review included five RCTs (n = 155). The main diagnoses were fibromyalgia and cervical dystonia. The interventions included submaximal contractions, aerobic exercise, physical therapy, and exercise combined with transcranial direct current stimulation. Three studies are considered to have a high risk of bias. All five studies showed significant pain improvement with exercise. The neurophysiological data revealed improvements in cortical excitability measured by motor-evoked potentials; standardized mean difference = 2.06, 95% confidence interval 1.35-2.78, I = 19%) but no significant differences in resting motor threshold. The data on intracortical inhibition/facilitation (ICI/ICF) was not systematically analyzed, but one study (n = 45) reported higher ICI and lower ICF after exercise.
These findings suggest that exercise interventions positively affect pain relief by modifying corticospinal excitability, but their effects on ICI/ICF are still unclear. While the results are inconclusive, they provide a basis for further exploration in this area of research; future studies should focus on establishing standardized TMS measurements and exercise protocols to ensure consistent and reliable findings. A large-scale RCT that examines various exercise interventions and their effects on cortical excitability could offer valuable insights to optimize its application in promoting neuroplasticity in pain populations.
经颅磁刺激（TMS）研究检查运动诱导的疼痛人群中的神经可塑性产生了矛盾的结果。我们进行了一项系统评价，以探索 TMS 指标如何影响疼痛人群的皮质兴奋性。本综述旨在总结效应大小，并了解其异质性的来源。
我们从成立到 2022 年 12 月搜索了多个数据库。我们纳入了任何类型疼痛人群的随机对照试验（RCT），包括急性和慢性疼痛；运动干预与假运动或其他主动干预进行比较。主要结局是 TMS 指标，疼痛强度是次要结局。使用 Cochrane 工具进行偏倚风险评估。
本综述纳入了五项 RCT（n=155）。主要诊断为纤维肌痛和颈性肌张力障碍。干预措施包括次最大收缩、有氧运动、物理治疗以及运动与经颅直流电刺激相结合。有三项研究被认为存在高偏倚风险。所有五项研究均表明运动可显著改善疼痛。神经生理学数据显示，运动可改善运动诱发电位测量的皮质兴奋性；标准化均数差=2.06，95%置信区间 1.35-2.78，I=19%），但静息运动阈值无显著差异。关于皮质内抑制/易化（ICI/ICF）的数据没有进行系统分析，但一项研究（n=45）报告运动后 ICI 升高和 ICF 降低。
这些发现表明，运动干预通过改变皮质脊髓兴奋性对缓解疼痛产生积极影响，但它们对 ICI/ICF 的影响仍不清楚。虽然结果不确定，但为进一步探索这一研究领域提供了基础；未来的研究应侧重于建立标准化的 TMS 测量和运动方案，以确保得出一致和可靠的结果。一项大型 RCT，研究各种运动干预及其对皮质兴奋性的影响，可能会为优化其在促进疼痛人群神经可塑性中的应用提供有价值的见解。
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