Yan Takyu, Liang Meizhen, Peng Jiahui, Yu Qiuhua, Li Yan, Yang Jiajia, Zhang Siyun, Wang Chuhuai
Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China.
Pain Ther. 2024 Aug;13(4):953-970. doi: 10.1007/s40122-024-00613-6. Epub 2024 Jun 19.
Patients with chronic non-specific low back pain (CNLBP) often experience impaired postural control, contributing to pain recurrence. Although repetitive peripheral magnetic stimulation (rPMS) combined with core muscle training (CMT) could improve postural control, its neural mechanism remains unclear. This study aims to investigate the postural control-related cortical mechanism of the effect of rPMS on patients with CNLBP.
This unicentric, prospective, randomized, double-blind, controlled trial was conducted in a public hospital from May to December 2023. A total of 40 patients (27 females and 13 males, mean age 29.38 ± 7.72) with CNLBP were randomly assigned to either the rPMS group (real rPMS with CMT) or the sham-rPMS group (sham-rPMS with CMT) for 12 sessions over 4 weeks. The rPMS was applied to the lumbar paravertebral multifidus muscle on the painful side. Pain and disability were quantified using the visual analog scale (VAS) and Oswestry dysfunction index (ODI) pre- and post-intervention. Furthermore, the sway area and velocity of the center of pressure (COP) were measured using a force platform. The cortical activities in 6 regions of interest during 4 tasks (standing with eyes open/closed on a stable/unstable plane) were recorded by functional near-infrared spectroscopy (fNIRS) pre- and post-intervention. The repeated measure ANOVA was applied for statistical analysis. Spearman's correlation was used to determine the relationships between variables.
After the intervention, the rPMS group showed decreased pain intensity (p = 0.001) and sway area (unstable eyes-closed task) (p = 0.046) compared to the sham-rPMS group. Additionally, the rPMS group exhibited increased activation in left primary motor cortex (M1) (p = 0.042) and reduced in left supplementary motor area (SMA) (p = 0.045), whereas the sham-rPMS group showed no significant changes. The increased activation of left M1 was negatively correlated to the reduction of pain intensity (r = - 0.537, p = 0.018) and sway area (r = - 0.500, p = 0.029) under the static balancing task. Furthermore, there was a positive correlation between sway velocity and VAS (r = 0.451, p = 0.046) post-rPMS intervention.
Repetitive peripheral magnetic stimulation combined with core muscle training demonstrated better analgesic effects and postural control improvements, compared to sham-stimulation. This may be attributed to the increased activation of the left primary motor cortex.
The trial was registered on ClinicalTrials.gov (ChiCTR2300070943).
慢性非特异性下腰痛（CNLBP）患者常出现姿势控制受损，这会导致疼痛复发。尽管重复外周磁刺激（rPMS）联合核心肌肉训练（CMT）可改善姿势控制，但其神经机制仍不清楚。本研究旨在探讨rPMS对CNLBP患者姿势控制影响的相关皮质机制。
本单中心、前瞻性、随机、双盲、对照试验于2023年5月至12月在一家公立医院进行。共40例CNLBP患者（27例女性，13例男性，平均年龄29.38±7.72岁）被随机分为rPMS组（真正的rPMS联合CMT）或假rPMS组（假rPMS联合CMT），在4周内进行12次治疗。rPMS应用于患侧腰段椎旁多裂肌。干预前后采用视觉模拟量表（VAS）和Oswestry功能障碍指数（ODI）对疼痛和功能障碍进行量化。此外，使用测力平台测量压力中心（COP）的摆动面积和速度。干预前后通过功能近红外光谱（fNIRS）记录4项任务（在稳定/不稳定平面上睁眼/闭眼站立）期间6个感兴趣区域的皮质活动。采用重复测量方差分析进行统计分析。Spearman相关性用于确定变量之间的关系。
干预后，与假rPMS组相比，rPMS组疼痛强度降低（p = 0.001），摆动面积（闭眼不稳定任务）降低（p = 0.046）。此外，rPMS组左侧初级运动皮层（M1）激活增加（p = 0.042），左侧辅助运动区（SMA）激活减少（p = 0.045），而假rPMS组无显著变化。在静态平衡任务下，左侧M1激活增加与疼痛强度降低（r = -0.537，p = 0.018）和摆动面积降低（r = -0.500，p = 0.029）呈负相关。此外，rPMS干预后摆动速度与VAS呈正相关（r = 0.451，p = 0.046）。
与假刺激相比，重复外周磁刺激联合核心肌肉训练显示出更好的镇痛效果和姿势控制改善。这可能归因于左侧初级运动皮层激活增加。
该试验已在ClinicalTrials.gov上注册（ChiCTR2300070943）。
