Background & Aims
Combining top-down with bottom-up intervention in patients with chronic low back pain (CLBP) is a new area research. This study aimed to investigate the combined effect of repetitive transcranial magnetic stimulation (rTMS) and sling exercise (SE) on motor cortex organization, pain intensity, daily activity, and postural balance in patients with CLBP. The study also compared these effects with those of rTMS or SE alone.
Methods
After the baseline assessment, patients with CLBP were randomly assigned to three groups: SE/rTMS, rTMS alone, and SE alone. All three groups trained five times a week for 2 weeks. The motor cortical organization was the primary outcome, while numerical pain rating scale (NPRS), Ostwetry Disability Index (ODI) and postural balance stability were secondary outcomes. Patients were assessed before and after two-week interventions.
Results
Combined SE/rTMS group reduced NPRS and ODI, induced motor cortical organization. Applied alone, rTMS or SE also reduced NPRS and improved neuroadaptive changes in the primary motor cortex. However, rTMS alone could not improve patients’ ODI. No changes were observed following postural balance stability. The combined SE/rTMS intervention was more effective than rTMS alone, but no different from SE alone.
Conclusions
The study provided evidence that a combined SE/rTMS intervention may produce greater clinical benefits than rTMS alone but had no difference from SE alone. Our results don’t support the use of rTMS as a standalone treatment for CLBP.
References
1.Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2021;396(10267):2006-2017.
2.Traeger AC, Buchbinder R, Elshaug AG, Croft PR, Maher CG. Care for low back pain: can health systems deliver? Bull World Health Organ. 2019;97(6):423-433.
3.Ferreira PH, Ferreira ML, Maher CG, Herbert RD, Refshauge K. Specific stabilisation exercise for spinal and pelvic pain: a systematic review. Aust J Physiother. 2006;52(2):79-88.
4.Hurri H, Vänni T, Muttonen E, Russo F, Iavicoli S, Ristolainen L. Functional Tests Predicting Return to Work of Workers with Non-Specific Low Back Pain: Are There Any Validated and Usable Functional Tests for Occupational Health Services in Everyday Practice? A Systematic Review. Int J Environ Res Public Health. 2023;20(6):5188.
5.Eun S, Lee J, Song EM, Rosa A, Lee JH, Park K. Brain functional connectivity changes by low back extension pain model in low back pain patients. PLoS One. 2020;15(6):e0233858.
6.Brumagne S, Diers M, Danneels L, Moseley GL, Hodges PW. Neuroplasticity of Sensorimotor Control in Low Back Pain. J Orthop Sports Phys Ther. 2019;49(6):402-414.
7.Tsao H, Galea MP, Hodges PW. Reorganization of the motor cortex is associated with postural control deficits in recurrent low back pain. Brain. 2008;131(Pt 8):2161-71.
8.Hodges PW, Danneels L. Changes in Structure and Function of the Back Muscles in Low Back Pain: Different Time Points, Observations, and Mechanisms. J Orthop Sports Phys Ther. 2019;49(6):464-476.
9.Massé-Alarie H, Beaulieu LD, Preuss R, Schneider C. The side of chronic low back pain matters: evidence from the primary motor cortex excitability and the postural adjustments of multifidi muscles. Exp Brain Res. 2017;235(3):647-659.
10.Schabrun SM, Elgueta-Cancino EL, Hodges PW. Smudging of the Motor Cortex Is Related to the Severity of Low Back Pain. Spine (Phila Pa 1976). 2017;42(15):1172-1178.
11.Li X, Liu H, Ge L, Yan Y, Lo WLA, Li L, Wang C. Cortical Representations of Transversus Abdominis and Multifidus Muscles Were Discrete in Patients with Chronic Low Back Pain: Evidence Elicited by TMS. Neural Plast. 2021; 2021:6666024.
Presenting Author
Xin Li
Poster Authors
Xin Li
Master's degree
The First Affiliated Hospital, Sun Yat-sen University
Lead Author
Songwei Lu
Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen
Lead Author
Chuhuai Wang
Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University
Lead Author
Topics
- Treatment/Management: Interventional Therapies – Neuromodulation