Zhang Shanshan, Zhang Guifang, Bao Shanshan, Tan Jiaqi, He Rongxing, Wang Hongjiang, Yan Shenglan, Wang Chuhuai
From the Department of Rehabilitation Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China (SZ, GZ, SB, JT, HW, SY, CW), and Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China (RH).
Am J Phys Med Rehabil. 2025 Mar 1;104(3):257-263. doi: 10.1097/PHM.0000000000002583. Epub 2024 Jul 29.
Chronic low back pain affects nociceptive responses in the cerebellum, which leads to increased pain perception and sensorimotor control dysfunction. This study aimed to investigate altered functional connectivity in the anterior and posterior lobes of the cerebellum during chronic low back pain.
Twenty patients with chronic low back pain and 18 healthy participants underwent 3.0 T resting-state functional magnetic resonance imaging. The bilateral lobule V of the anterior cerebellum and Crus I of the posterior cerebellum were selected as the region of interest for identifying the corresponding networks.
The left lobule V had a greater intrinsic connectivity with the left insular cortex, left orbitofrontal cortex, and bilateral medial prefrontal cortex in patients with chronic low back pain. In contrast, the right lobule V and bilateral Crus I had a significantly decreased connectivity with the contralateral multimodal cerebral networks, including the default mode network, salience network, and emotional network.
The cerebellum had mechanistic implications in pain-related changes, which are involved in motor control, cognition, and emotion processing. These findings provide a novel perspective on the role of functional subregions in chronic low back pain, which add to the growing body of evidence that the cerebellum can be a potential target for noninvasive brain stimulation for chronic pain treatment.
慢性下腰痛会影响小脑的伤害性反应，进而导致疼痛感知增加和感觉运动控制功能障碍。本研究旨在调查慢性下腰痛期间小脑前叶和后叶功能连接的改变。
20例慢性下腰痛患者和18名健康参与者接受了3.0T静息态功能磁共振成像检查。选择小脑前叶的双侧小叶V和小脑后叶的 Crus I作为感兴趣区域，以识别相应的网络。
慢性下腰痛患者的左侧小叶V与左侧岛叶皮质、左侧眶额皮质和双侧内侧前额叶皮质具有更强的内在连接。相比之下，右侧小叶V和双侧Crus I与对侧多模态脑网络（包括默认模式网络、突显网络和情感网络）的连接显著减少。
小脑在与疼痛相关的变化中具有机制性影响，这些变化涉及运动控制、认知和情绪处理。这些发现为慢性下腰痛中功能亚区的作用提供了新的视角，这进一步证明了小脑可能是慢性疼痛治疗中非侵入性脑刺激的潜在靶点。
