scholarly journals Neuroimaging Studies of Acupuncture on Low Back Pain: A Systematic Review

2021 ◽  
Vol 15 ◽  
Author(s):  
Qiao Wen ◽  
Peihong Ma ◽  
Xiaohui Dong ◽  
Ruirui Sun ◽  
Lei Lan ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Brain Regions ◽  
Risk Of Bias ◽  
Anterior Cingulate ◽  
Low Back ◽  
Imaging Data ◽  
China National Knowledge Infrastructure ◽  
Functional Changes ◽  
The Brain

Objectives: This study was conducted in order to investigate the study design and main outcomes of acupuncture neuroimaging studies on low back pain (LBP).Methods: Neuroimaging studies of acupuncture on LBP were collected from three English databases such as PubMed and four Chinese databases such as China National Knowledge Infrastructure (CNKI) from inception to December 31, 2020. Study selection, data extraction, and assessment of risk of bias were performed independently by two investigators. The quality of studies was appraised with the Cochrane's risk of bias tools. Information on basic information, methodology, and brain imaging data were extracted.Results: The literature search returned 310 potentially eligible studies and 19 articles met inclusion criteria; 78.9% of studies chose manual acupuncture as the intervention, 89.5% of studies evaluated functional changes elicited by acupuncture, and 68.4% of studies used resting-state fMRI as imaging condition. The most frequently reported acupuncture-induced brain alterations of LBP patients were in the prefrontal cortex, insula, cerebellum, primary somatosensory cortex, and anterior cingulate cortex. There was a significant correlation between improved clinical outcomes and changes in the brain.Conclusions: The results suggested that improving abnormal structure and functional activities in the brain of the LBP patient is an important mechanism of acupuncture treatment for LBP. The brain regions involved in acupuncture analgesia for LBP were mainly located in the pain matrix, default mode network (DMN), salience network (SN), and descending pain modulatory system (DPMS). However, it was difficult to draw a generalized conclusion due to the heterogeneity of study designs. Further well-designed multimodal neuroimaging studies investigating the mechanism of acupuncture on LBP are warranted.

scholarly journals The genetic influence of the brain-derived neurotrophic factor Val66Met polymorphism in chronic low back pain

2021 ◽  
Vol 61 (1) ◽  
Author(s):  
Angela Shiratsu Yamada ◽  
Flavia Tasmim Techera Antunes ◽  
Camila Ferraz ◽  
Alessandra Hubner de Souza ◽  
Daniel Simon
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Neurotrophic Factor ◽  
Central Sensitization ◽  
Low Back ◽  
Bdnf Gene ◽  
Val66met Polymorphism ◽  
Bdnf Val66met Polymorphism ◽  
The Brain

Abstract Background The Val66Met polymorphism of the brain-derived neurotrophic factor (BDNF) gene is a potential biomarker of vulnerability to pain. Thus, the present study aimed to investigate the association of this polymorphism with clinical and biopsychosocial factors in patients with chronic low back pain (CLBP). Methods A total of 107 individuals with CLBP answered questionnaires that were validated and adapted for the Brazilian population, including the Brief Inventory of Pain, the Central Sensitization Inventory, the Roland Morris Disability Questionnaire, the Tampa Scale for Kinesiophobia, the Pain Catastrophizing Scale, the Survey of Pain Attitude-Brief, and the Hospital Anxiety and Depression Scale. All of the subjects were genotyped for the BDNF Val66Met polymorphism. Results The sample showed moderate scores of disability, central sensitization, and kinesiophobia, in addition to mild anxiety, hopelessness, and ruminant thoughts. No significant association was observed between the Val66Met polymorphism and the variables analyzed. Besides, there was no relationship between the BDNF Val66Met polymorphism with CSI, catastrophization, or disabilities that were generated by CLBP. Conclusion The results showed that the Val66Met polymorphism of the BDNF gene was not associated with clinical and biopsychosocial characteristics of CLBP in the sample studied.

scholarly journals Psychological interventions for chronic non-specific low back pain: protocol of a systematic review with network meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e034996
Author(s):  
Emma Ho ◽  
Manuela Ferreira ◽  
Lingxiao Chen ◽  
Milena Simic ◽  
Claire Ashton-James ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Psychological Interventions ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Low Back ◽  
Fear Avoidance

IntroductionPsychological factors such as fear avoidance beliefs, depression, anxiety, catastrophic thinking and familial and social stress, have been associated with high disability levels in people with chronic low back pain (LBP). Guidelines endorse the integration of psychological interventions in the management of chronic LBP. However, uncertainty surrounds the comparative effectiveness of different psychological approaches. Network meta-analysis (NMA) allows comparison and ranking of numerous competing interventions for a given outcome of interest. Therefore, we will perform a systematic review with a NMA to determine which type of psychological intervention is most effective for adults with chronic non-specific LBP.Methods and analysisWe will search electronic databases (MEDLINE, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, SCOPUS and CINAHL) from inception until 22 August 2019 for randomised controlled trials comparing psychological interventions to any comparison interventions in adults with chronic non-specific LBP. There will be no restriction on language. The primary outcomes will include physical function and pain intensity, and secondary outcomes will include health-related quality of life, fear avoidance, intervention compliance and safety. Risk of bias will be assessed using the Revised Cochrane risk-of-bias tool for randomised trials (RoB 2) tool and confidence in the evidence will be assessed using the Confidence in NMA (CINeMA) framework. We will conduct a random-effects NMA using a frequentist approach to estimate relative effects for all comparisons between treatments and rank treatments according to the mean rank and surface under the cumulative ranking curve values. All analyses will be performed in Stata.Ethics and disseminationNo ethical approval is required. The research will be published in a peer-reviewed journal.PROSPERO registration numberCRD42019138074.

Differences in Activity of the Brain Networks During Voluntary Motor Tasks Engaging the Local and Global Muscular Systems of the Lower Trunk

Motor Control ◽  
2020 ◽  
Vol 24 (4) ◽  
pp. 624-643 ◽  
Author(s):  
Rafael Gnat ◽  
Agata Dziewońska ◽  
Maciej Biały ◽  
Martyna Wieczorek
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Voluntary Contraction ◽  
Abdominal Muscles ◽  
Low Back ◽  
Motor Tasks ◽  
Default Mode ◽  
Lower Trunk ◽  
Central Nervous System Activity ◽  
The Brain

Low back pain constitutes a multidimensional problem of largely unknown origin. One of the recent theories explaining its frequent occurrence includes speculative statements on patterns of central nervous system activity associated with the control of so-called local and global muscles of the lower trunk. The objective of the study was to verify whether there is a difference in the activity of the brain during selective, voluntary contraction of the local and global abdominal muscles as assessed by functional MRI. Twenty healthy subjects participated. An experimental design was applied with repeated measurements of the blood-oxygen-level–dependent signal from the brain during voluntary contraction of the local and global abdominal muscles, performed in random order. Prior to registration, a 2-week training period was introduced, aiming to master the experimental motor tasks. The magnetic resonance imaging (MRI) data were processed using the FMRIB Software Library (Oxford, UK). Brain areas showing significant activations/deactivations were identified and averaged across all participants, and intercondition differential maps were computed. Areas of significant intercondition differences were linked to the corresponding anatomical structures and ascribed to the default mode functional brain network and to the sensorimotor network. Contraction of the local abdominal muscles elicited more pronounced activity of the brain cortex, basal ganglia, and cerebellum. This suggests that motor control of the abdominal musculature consists of two modes of brain activity and that control of the local muscles may be a more challenging task for the brain. Moreover, contraction of the local muscles elicited more distinct deactivation of the default mode network, which may have implications for diagnostics and therapy of low back pain.

scholarly journals An Osteopathic Approach to Uterine-Induced Low Back Pain: A Case Report

2019 ◽  
Vol 29 (3) ◽  
pp. 23-26
Author(s):  
David M. Kanze
Keyword(s):  
Adverse Reaction ◽  
Low Back Pain ◽  
Back Pain ◽  
Case Report ◽  
Package Insert ◽  
The Body ◽  
Low Back ◽  
Intrauterine Devices ◽  
Functional Changes ◽  
Uterosacral Ligaments

Abstract Uterine-induced low back pain is primarily caused by pregnancy. More than 50% of women will experience it while pregnant.1 Many of these changes are postural in nature and can last into the postpartum period.1–3 There is also increased stress placed about the uterosacral ligaments and sacrum.1,4–6 Back pain related to intrauterine devices (IUD) is less common than pregnancy-induced back pain, but it is still commonly present and is a common enough adverse reaction that it is listed on the package insert.7 An osteopathic approach to uterine-induced low back pain looks at the structural and functional changes caused by changes in the uterus and the resultant changes on the remainder of the body. The present case depicts this approach and possible anatomic reasoning to why and how this pain is present.

scholarly journals Neuromuscular adaptations to experimentally induced pain in the lumbar region: protocol for a systematic review and meta-analysis

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Valter Devecchi ◽  
Deborah Falla ◽  
Hélio V. Cabral ◽  
Alessio Gallina
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Meta Analysis ◽  
Experimental Pain ◽  
Neuromuscular Control ◽  
Risk Of Bias ◽  
Lumbar Region ◽  
Low Back ◽  
Experimentally Induced

Abstract Background Numerous studies report changes in neuromuscular control in people with low back pain (LBP). However, the relationship between pain and altered neuromuscular control is challenging to unravel given the heterogeneity that exists in clinical populations. One approach commonly adopted to overcome this issue is the use of experimental pain models, but it is currently unclear if the effects of experimental pain are consistent between studies. Therefore, this planned study will systematically evaluate and summarise the effect of experimentally induced pain in the lumbar region on neuromuscular control at sites both locally and remote to the low back. Methods This protocol has been developed following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). MEDLINE, EMBASE, CINAHL, ZETOC, Web of Science, and grey literature will be searched up to August 31, 2021. Screening processes (title/abstract and full-text), data extraction, and risk of bias assessment will be conducted by two independent reviewers. Studies investigating the effects of exogenous pain models delivered to the low back region on neuromuscular control in healthy individuals will be included. Muscle activity and body kinematics will be the outcomes of interest. The comparisons of interest will be between baseline or control conditions and the experimental pain condition, as well as between the experimental pain and post-pain conditions. Randomised crossover and non-randomised studies of interventions will be included and their risk of bias will be evaluated with the Cochrane Risk-of-Bias tool or with the Risk Of Bias In Non-randomised Studies of Interventions tool, respectively. A random-effect meta-analysis will be conducted for quantitative synthesis when clinical and methodological consistency is ensured. Quality of evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation guidelines. Discussion The current review will provide new insights to understand if and what neuromuscular adaptations are caused by pain experimentally induced in the lumbar region. Our findings will reveal which experimental pain model is able to better reproduce adaptations similar to those identified in people with low back pain, possibly contributing to improving our understanding of motor adaptation to low back pain in the long term. Systematic review registration PROSPERO CRD42020220130

scholarly journals Brain Activation in Chronic Nonspecific Low Back Pain : A Systematic review and ALE Meta-analysis

2021 ◽  
Author(s):  
Sandipan Hazra ◽  
Samantak Sahu ◽  
Prasunpriya Nayak ◽  
Kaushik Sarkar ◽  
Srikumar Venkataraman ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Brain Imaging ◽  
Meta Analysis ◽  
Functional Brain Imaging ◽  
Pain Modulation ◽  
Anterior Cingulate ◽  
Protective Mechanism ◽  
Low Back ◽  
Stimulation Group

Pain, a protective mechanism turns into a pathologic response when it becomes chronic. Recent evidences are pointing towards neuroplastic brain changes as the primary factor for the persisting pain in chronic nonspecific low back pain (cLBP). To summarise the previous fMRI studies, a coordinate-based ALE meta-analysis of resting functional brain imaging studies is carried out to identify the clusters activated in the brain in cLBP. Literature survey: PubMed, Scopus and Sleuth were searched for studies with resting functional whole-brain imaging in cLBP. Till October 2020; 258, 238, and 7 studies were found respectively after search. The activity pattern was documented in without stimulation and with stimulation groups. The risk of bias was assessed by Joanna Briggs Institute critical appraisal checklist for analytical cross-section studies. Total seven (224 cLBP patients, 110 activation foci) and six studies (106 cLBP patients, 66 activation foci) were selected among 277 studies for metanalysis in the without stimulation and with stimulation group respectively. In the without stimulation group 8 statistically significant clusters were found. The clusters are distributed in the prefrontal cortex, primary somatosensory cortex, and primary motor cortex, anterior cingulate cortex, insular cortex, putamen, claustrum, amygdala, and associated white matters in both hemispheres. On the other group, 3 statistically significant clusters were found in the frontal cortex, Parietal cortex, and Insula. In the with stimulation group, significant lateralization was observed and most of the clusters were in the right hemisphere. The white matter involvement was more in the with stimulation group (78.62% Vs 38.21%). The statistically significant clusters found in this study indicate a probable imbalance in GABAergic modulation of brain circuit and dysfunction in descending pain modulation system. This disparity in pain neuro-matrix is the source of spontaneous and persisting pain in cLBP.

scholarly journals Identification of brain regions associated with working memory deficit in schizophrenia

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 124 ◽  
Author(s):  
Indranath Chatterjee ◽  
Virendra Kumar ◽  
Sahil Sharma ◽  
Divyanshi Dhingra ◽  
Bharti Rana ◽  
...  
Keyword(s):  
Working Memory ◽  
Clinical Investigation ◽  
Brain Regions ◽  
Medical Intervention ◽  
Memory Deficit ◽  
Psychological Disorder ◽  
Imaging Data ◽  
Functional Changes ◽  
Statistical Measures ◽  
The Brain

Background: Schizophrenia, a severe psychological disorder, shows symptoms such as hallucinations and delusions. In addition, patients with schizophrenia often exhibit a deficit in working memory which adversely impacts the attentiveness and the behavioral characteristics of a person. Although several clinical efforts have already been made to study working memory deficit in schizophrenia, in this paper, we investigate the applicability of a machine learning approach for identification of the brain regions that get affected by schizophrenia leading to the dysfunction of the working memory. Methods: We propose a novel scheme for identification of the affected brain regions from functional magnetic resonance imaging data by deploying group independent component analysis in conjunction with feature extraction based on statistical measures, followed by sequential forward feature selection. The features that show highest accuracy during the classification between healthy and schizophrenia subjects are selected. Results: This study reveals several brain regions like cerebellum, inferior temporal gyrus, superior temporal gyrus, superior frontal gyrus, insula, and amygdala that have been reported in the existing literature, thus validating the proposed approach. We are also able to identify some functional changes in the brain regions, such as Heschl gyrus and the vermian area, which have not been reported in the literature involving working memory studies amongst schizophrenia patients. Conclusions: As our study confirms the results obtained in earlier studies, in addition to pointing out some brain regions not reported in earlier studies, the findings are likely to serve as a cue for clinical investigation, leading to better medical intervention.

scholarly journals Frequency-Specific Blood Oxygen Level Dependent Oscillations Associated With Pain Relief From Ankle Acupuncture in Patients With Chronic Low Back Pain

2021 ◽  
Vol 15 ◽  
Author(s):  
Anfeng Xiang ◽  
Meiyu Chen ◽  
Chuan Qin ◽  
Jun Rong ◽  
Can Wang ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Relief ◽  
Chronic Low Back Pain ◽  
Resting State ◽  
Healthy Controls ◽  
Low Back ◽  
Acupuncture Analgesia ◽  
Mixed Effect ◽  
Functional Changes

Objective: Recent advances in brain imaging have deepened our knowledge of the neural activity in distinct brain areas associated with acupuncture analgesia. However, there has not been conclusive research into the frequency-specific resting-state functional changes associated with acupuncture analgesia in patients with chronic pain. Here, we aimed to characterize changes across multiple frequencies of resting-state cortical activity associated with ankle acupuncture stimulation (AAS) in patients with chronic low back pain (CLBP) and healthy controls.Methods: Twenty seven patients with CLBP and Twenty five age- and gender-matched healthy volunteers were enrolled in the study. Participants received tactile sham acupuncture (TSA) and AAS, respectively. The whole-brain amplitude of low-frequency fluctuation (ALFF) in the range 0.01–0.25 Hz was assessed for changes associated with each intervention. Further, a visual analog scale (VAS) was used to collect subjective measures of pain intensity in patients. Linear mixed-effect modeling (LME) was used to examine the mean ALFF values of AAS and TSA between patients and healthy controls.Results: The ALFF was modulated in the default mode network (an increase in the medial prefrontal cortex, and a decrease in the cerebellum/posterior ingulate/parahippocampus, P < 0.01, corrected) in both patients and controls. Decreased ALFF in the bilateral insular was frequency-dependent. Modulations in the cerebellum and right insular were significantly correlated with VAS pain score after AAS (P < 0.01).Conclusion: Hence, frequency-specific resting-state activity in the cerebellum and insular was correlated to AAS analgesia. Our frequency-specific analysis of ALFF may provide novel insights related to pain relief from acupuncture.

scholarly journals The association between depressive symptoms or depression and health outcomes in adults with low back pain with or without radiculopathy: protocol of a systematic review

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Jessica J. Wong ◽  
Andrea C. Tricco ◽  
Pierre Côté ◽  
Laura C. Rosella
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Depressive Symptoms ◽  
Health Outcomes ◽  
Risk Of Bias ◽  
Considerable Proportion ◽  
Low Back ◽  
The Impact

Abstract Background A considerable proportion of adults with low back pain (LBP) suffer from depressive symptoms or depression. Those with depressive symptoms or depression may be at risk of poorer LBP recovery and require more health care. Understanding the role of prognostic factors for LBP is critically important to guide management and health services delivery. Our objective is to conduct a systematic review to assess the association between depressive symptoms or depression and health outcomes in adults with LBP with or without radiculopathy. Methods Electronic databases including MEDLINE, Embase, CINAHL, and PsycINFO will be searched from inception to April 2019 to identify relevant studies. Additional citations will be identified by searching reference lists of included studies and related systematic reviews. Cohort and case-control studies assessing the association between depressive symptoms/depression and health outcomes in adults aged 16 years and older with LBP with or without radiculopathy will be included. The following will be included: depressive symptoms as measured on standardized questionnaires (e.g., Center for Epidemiologic Studies Depression Scale, Beck Depression Index), and depression as standardized diagnoses (e.g., International Classification of Diseases codes) or self-reported depression diagnosis on standardized questionnaires. Outcomes of interest are standardized measures for pain, disability, overall health status, satisfaction with care, and health care utilization. These are informed by core outcome domains that international expert panels consider important for LBP research. Pairs of reviewers will screen articles retrieved from the search, extract data, and assess risk of bias using the Risk Of Bias In Non-randomized Studies-of Exposures (ROBINS-E) tool. Reviewers will use these criteria to inform their judgment on the internal validity of studies (e.g., low, moderate, or high risk of bias). If studies are deemed homogeneous, a random effects meta-analysis on the association between depressive symptoms and health outcomes will be performed. The results of the included studies will be descriptively outlined if studies are deemed heterogeneous. Discussion The impact of depressive symptoms and depression on health- and health care-related outcomes for LBP with or without radiculopathy will be assessed and quantified. Findings of this systematic review will advance our understanding of LBP prognosis, and guide decision-making and improve quality of care for adults with LBP. Systematic review registration PROSPERO CRD42019130047

scholarly journals Loss of nucleus accumbens low-frequency fluctuations is a signature of chronic pain

2020 ◽  
Vol 117 (18) ◽  
pp. 10015-10023 ◽  
Author(s):  
Meena M. Makary ◽  
Pablo Polosecki ◽  
Guillermo A. Cecchi ◽  
Ivan E. DeAraujo ◽  
Daniel S. Barron ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Low Back Pain ◽  
Back Pain ◽  
Nucleus Accumbens ◽  
Chronic Low Back Pain ◽  
Chronic Back Pain ◽  
Chronic Phase ◽  
Anterior Cingulate ◽  
Low Back ◽  
Pain Patients

Chronic pain is a highly prevalent disease with poorly understood pathophysiology. In particular, the brain mechanisms mediating the transition from acute to chronic pain remain largely unknown. Here, we identify a subcortical signature of back pain. Specifically, subacute back pain patients who are at risk for developing chronic pain exhibit a smaller nucleus accumbens volume, which persists in the chronic phase, compared to healthy controls. The smaller accumbens volume was also observed in a separate cohort of chronic low-back pain patients and was associated with dynamic changes in functional connectivity. At baseline, subacute back pain patients showed altered local nucleus accumbens connectivity between putative shell and core, irrespective of the risk of transition to chronic pain. At follow-up, connectivity changes were observed between nucleus accumbens and rostral anterior cingulate cortex in the patients with persistent pain. Analysis of the power spectral density of nucleus accumbens resting-state activity in the subacute and chronic back pain patients revealed loss of power in the slow-5 frequency band (0.01 to 0.027 Hz) which developed only in the chronic phase of pain. This loss of power was reproducible across two cohorts of chronic low-back pain patients obtained from different sites and accurately classified chronic low-back pain patients in two additional independent datasets. Our results provide evidence that lower nucleus accumbens volume confers risk for developing chronic pain and altered nucleus accumbens activity is a signature of the state of chronic pain.

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