• Chanjuan Zhang, Yuelong Li, Zhou Zhang, Ruochen Fu, Yi Yin, Hongjiang Wang, Na Li, Chenyang Feng, Qiuhua Yu, Guihua Jiang, and Chuhuai Wang.
• Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, P.R. China; Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, P.R. China.
• Pain Physician. 2024 Jan 1; 27 (1): E55E64E55-E64.

BackgroundMotor control exercise (MCE) effectively alleviates nonspecific chronic low back pain (CLBP), but the neural mechanisms underlying this phenomenon are poorly understood.ObjectiveTo study MCE's neural mechanisms in patients with CLBP by resting-state functional magnetic resonance imaging (rs-fMRI).Study DesignA prospective, single-blind, randomized, controlled trial.SettingDepartment of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University.Methods58 patients were randomly assigned to either the MCE or the Manual Therapy (MT) group. Before and after treatment, all the patients underwent ultrasound imaging to measure transversus abdominis (TrA) activation, rs-fMRI scans and questionnaire assessments. We analyzed the activation and connectivity of the bilateral precuneus based on the fractional amplitude of low-frequency fluctuation (fALFF) and effective connectivity (EC) analyses. Further, we determined the association between imaging and clinical measures.ResultsPain intensity, pain catastrophizing, and pain-related disability were alleviated significantly in both groups post-treatment. However, the MCE group showed a greater reduction in pain-related disability and a better improvement in activation of the right TrA than the MT group. After MCE, patients showed an increase in regional fALFF values in the key node of the default mode network (bilateral precuneus) and decreased EC from the bilateral precuneus to the key node of the frontoparietal network (the left dorsolateral prefrontal cortex (DLPFC)). The pre-to-post-treatment change in the EC from bilateral precuneus into the left DLPFC was significantly correlated with the pre-to-post-treatment change in visual analog scale scores and activation of the right TrA in the MCE group (r = 0.765, P < 0.001 and r = 0.481 and P = 0.043 respectively).LimitationsThe present study showes the correlation between the alteration of brain functions and CLBP-related symptoms, which does not reveal the causal effect between them. Further, this study does not estimate the long-term efficacy of MCE on brain function, and the sample size was not calculated based on fMRI data.ConclusionThese findings demonstrate that MCE may alleviate CLBP symptoms in patients by modifying information transmission from the default mode network to the left frontoparietal network.

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