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慢性下腰痛患者经颅直流电刺激背外侧前额叶皮质的神经肌肉特征：一项随机、双盲、对照试验方案

Neuromuscular characteristics of transcranial direct current stimulation over dorsolateral prefrontal cortex in patients with chronic low back pain: a randomized, double-blind, controlled trial protocol.

作者信息

Li Xin, Liang Wenzhao, Li Zhicheng, Li Shijue, Zu Yao, Ge Le, Wang Chuhuai

机构信息

Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.

出版信息

Front Hum Neurosci. 2025 Jul 9;19:1586257. doi: 10.3389/fnhum.2025.1586257. eCollection 2025.

DOI:10.3389/fnhum.2025.1586257
PMID:40703403
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12283631/
Abstract

BACKGROUND: Chronic low back pain (cLBP) is a prevalent condition associated with poor rehabilitation outcomes and high recurrence rates. Previous studies suggest that the number, structure, and network patterns of trunk muscle synergy may contribute to this condition. Our previous research mapped the neural representation of cLBP trunk muscles in the primary motor cortex (M1) and identified a disrupted M1-trunk muscle synergy pattern. Recent studies indicate that the dorsolateral prefrontal cortex (DLPFC) has a key role in the internal connectivity of cLBP patients when coping with chronic pain. This study aims to determine whether transcranial direct current stimulation (tDCS) of the DLPFC in cLBP patients can enhance the activity and functional connectivity of M1 and DLPFC, thus improving abnormal trunk muscle synergy. METHODS: This study is a randomized, double-blind, controlled trial. Forty-eight individuals aged 20 to 55 years with cLBP will be randomly assigned to receive either (1) a 3-week DLPFC-tDCS intervention ( = 24) or (2) a 3-week M1-tDCS intervention ( = 24), administered four times per week for a total of 12 sessions. Clinical outcomes will be assessed at baseline, 3 weeks, and 6 and 12 months after randomization. Primary outcomes include pain intensity, disability, and scores on the Hamilton Depression and Hamilton Anxiety scales. Secondary outcomes include surface electromyography characteristics of trunk muscles, oxygenated and deoxygenated hemoglobin concentrations in the M1 and DLPFC, and functional connectivity between these two brain regions. These outcomes will be evaluated before and after the intervention. Effect sizes and a mixed-model repeated measures analysis of variance (2 groups × 4 time points) will be calculated. DISCUSSION: The results of this trial will clarify the efficacy of DLPFC-tDCS in enhancing M1-DLPFC functional connectivity and improving trunk muscle synergy patterns. These findings will provide a theoretical foundation for developing new therapeutic targets for the treatment of cLBP. CLINICAL TRIAL REGISTRATION: https://www.chictr.org.cn, identifier ChiCTR2300078887.

摘要

背景：慢性下腰痛（cLBP）是一种常见病症，与康复效果不佳和复发率高相关。先前的研究表明，躯干肌肉协同作用的数量、结构和网络模式可能导致这种情况。我们之前的研究绘制了cLBP患者躯干肌肉在初级运动皮层（M1）中的神经表征，并确定了M1-躯干肌肉协同模式的破坏。最近的研究表明，背外侧前额叶皮层（DLPFC）在cLBP患者应对慢性疼痛时的内在连接中起关键作用。本研究旨在确定对cLBP患者的DLPFC进行经颅直流电刺激（tDCS）是否能增强M1和DLPFC的活动及功能连接，从而改善异常的躯干肌肉协同作用。 方法：本研究是一项随机、双盲、对照试验。48名年龄在20至55岁之间的cLBP患者将被随机分配接受以下两种干预之一：（1）为期3周的DLPFC-tDCS干预（n = 24）或（2）为期3周的M１-tDCS干预（n = 24），每周进行4次，共12次。在基线、3周、随机分组后6个月和12个月时评估临床结果。主要结果包括疼痛强度、残疾程度以及汉密尔顿抑郁量表和汉密尔顿焦虑量表的得分。次要结果包括躯干肌肉的表面肌电图特征、M1和DLPFC中氧合血红蛋白和脱氧血红蛋白的浓度，以及这两个脑区之间的功能连接。这些结果将在干预前后进行评估。将计算效应量和混合模型重复测量方差分析（2组×4个时间点）。 讨论：本试验的结果将阐明DLPFC-tDCS在增强M1-DLPFC功能连接和改善躯干肌肉协同模式方面的疗效。这些发现将为开发治疗cLBP的新治疗靶点提供理论基础。 临床试验注册：https://www.chictr.org.cn，标识符ChiCTR2300078887。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bc97/12283631/111fa7da63ec/fnhum-19-1586257-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bc97/12283631/d52d2a4fb434/fnhum-19-1586257-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bc97/12283631/7d0f8ecd82fd/fnhum-19-1586257-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bc97/12283631/1b1b5b0889e5/fnhum-19-1586257-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bc97/12283631/111fa7da63ec/fnhum-19-1586257-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bc97/12283631/d52d2a4fb434/fnhum-19-1586257-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bc97/12283631/7d0f8ecd82fd/fnhum-19-1586257-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bc97/12283631/1b1b5b0889e5/fnhum-19-1586257-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bc97/12283631/111fa7da63ec/fnhum-19-1586257-g004.jpg

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本文引用的文献

[1]
Recent clinical practice guidelines for the management of low back pain: a global comparison.

BMC Musculoskelet Disord. 2024-5-1

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Front Neurosci. 2023-10-13

[3]
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BMJ Open. 2023-10-19

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Cortical Representations of Transversus Abdominis and Multifidus Muscles Were Discrete in Patients with Chronic Low Back Pain: Evidence Elicited by TMS.

Neural Plast. 2021

[10]
Generalization of motor module recruitment across standing reactive balance and walking is associated with beam walking performance in young adults.

Gait Posture. 2020-10

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