Coppieters Iris, Nijs Jo, Meeus Mira, Danneels Lieven, Roussel Nathalie, Cagnie Barbara, Kregel Jeroen, Willaert Ward, Rheel Emma, De Pauw Robby, Malfliet Anneleen
Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103-Building F, 1090 Brussels, Belgium.
Experimental Health Psychology Research Group, Faculty of Psychology and Neuroscience, Maastricht University, 6211 LK Maastricht, The Netherlands.
J Clin Med. 2025 Jan 28;14(3):867. doi: 10.3390/jcm14030867.
White matter (WM) structural changes have been found in patients with chronic spinal pain (CSP). In these patients, pain neuroscience education followed by cognition-targeted exercise therapy (i.e., the Modern Pain Neuroscience Approach (MPNA)) was shown to be more effective than biomedically-focused education followed by symptom-contingent exercise therapy for improving clinical outcomes. The present study examined whether an MPNA, compared to biomedically-focused treatment, can change WM structure in regions of interest and whether potential WM structural changes are associated with clinical improvements in patients with CSP. : Patients with CSP were randomized into an experimental (MPNA) or control (biomedically-focused) treatment group. Diffusion-weighted Magnetic Resonance Images were acquired pre-treatment, post-treatment, and at 1-year follow-up. WM structure was assessed using diffusion tensor imaging in 8 WM regions of interest, and linear mixed models assessed differences between groups in response to treatment. : No significant treatment x time interaction effects were found; however, significant main effects of time were found in 7 WM tracts. Significant main effects of time revealed increased fractional anisotropy (FA), decreased mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) in the cingulum hippocampus, and decreased RD and MD in the superior cerebellar peduncle at 1-year follow-up compared to baseline. In contrast, decreased FA and/or increased MD, AD, or RD values were found in other WM tracts (e.g., anterior corona radiata) from pre-treatment to 1-year follow-up. Greater reduction in kinesiophobia was moderately correlated with a smaller decrease in RD in the superior cerebellar peduncle at 1-year follow-up compared to baseline. No other significant associations were found between WM structural changes and clinical improvements. : In conclusion, in patients with CSP, regional WM structure changed over time irrespective of prescribed treatment (timespan of 12 months). Further research, including Neurite Orientation Dispersion and Density Imaging and a healthy control group, allowing for a more specific examination of WM microstructural changes in response to multimodal treatment in patients with CSP, is warranted.
慢性脊柱疼痛（CSP）患者已被发现存在白质（WM）结构变化。在这些患者中，疼痛神经科学教育后进行认知靶向运动疗法（即现代疼痛神经科学方法（MPNA））在改善临床结局方面比以生物医学为重点的教育后进行症状相关运动疗法更有效。本研究调查了与以生物医学为重点的治疗相比，MPNA是否能改变感兴趣区域的WM结构，以及潜在的WM结构变化是否与CSP患者的临床改善相关。：CSP患者被随机分为实验组（MPNA）或对照组（以生物医学为重点）治疗组。在治疗前、治疗后和1年随访时采集扩散加权磁共振图像。使用扩散张量成像在8个WM感兴趣区域评估WM结构，线性混合模型评估组间对治疗反应的差异。：未发现显著的治疗×时间交互作用效应；然而，在7条WM束中发现了显著的时间主效应。时间的显著主效应显示，与基线相比，在1年随访时，扣带回海马体的分数各向异性（FA）增加，平均扩散率（MD）、轴向扩散率（AD）和径向扩散率（RD）降低，上小脑脚的RD和MD降低。相比之下，从治疗前到1年随访，在其他WM束（如放射冠前部）中发现FA降低和/或MD、AD或RD值增加。与基线相比，在1年随访时，运动恐惧更大程度的降低与上小脑脚RD较小程度的降低中度相关。未发现WM结构变化与临床改善之间的其他显著关联。：总之，在CSP患者中，无论规定的治疗方法如何（12个月的时间跨度），区域WM结构都会随时间发生变化。有必要进行进一步的研究，包括神经突方向离散度和密度成像以及健康对照组，以便更具体地检查CSP患者对多模式治疗反应的WM微观结构变化。
