Abstract
Chronic low back pain (cLBP) has been associated with changes in brain plasticity.
Nonpharmacological therapies such as Manual Therapy (MT) have shown promise for relieving
cLBP. However, translational neuroimaging research is needed to understand potential
central mechanisms supporting MT. We investigated the effect of MT on resting-state
salience network (SLN) connectivity, and whether this was associated with changes
in clinical pain. Fifteen cLBP patients, and 16 matched healthy controls (HC) were
scanned with resting functional Magnetic Resonance Imaging (fMRI), before and immediately
after a MT intervention (cross-over design with two separate visits, pseudorandomized,
grades V ‘Manipulation’ and III ‘Mobilization’ of the Maitland Joint Mobilization
Grading Scale). Patients rated clinical pain (0–100) pre- and post-therapy. SLN connectivity
was assessed using dual regression probabilistic independent component analysis. Both
manipulation (Pre: 39.43 ± 16.5, Post: 28.43 ± 16.5) and mobilization (Pre: 38.83
± 17.7, Post: 31.76 ± 19.4) reduced clinical back pain (P < .05). Manipulation (but not mobilization) significantly increased SLN connectivity
to thalamus and primary motor cortex. Additionally, a voxelwise regression indicated
that greater MT-induced increase in SLN connectivity to the lateral prefrontal cortex
was associated with greater clinical back pain reduction immediately after intervention,
for both manipulation (r = -0.8) and mobilization (r = -0.54). Our results suggest
that MT is successful in reducing clinical low back pain by both spinal manipulation
and spinal mobilization. Furthermore, this reduction post-manipulation occurs via
modulation of SLN connectivity to sensorimotor, affective, and cognitive processing
regions.
Perspective
MT both reduces clinical low back pain and modulates brain activity important for
the processing of pain. This modulation was shown by increased functional brain connectivity
between the salience network and brain regions involved in cognitive, affective, and
sensorimotor processing of pain.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of PainAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The role of activity in the therapeutic management of back pain. Report of the International Paris Task Force on Back Pain.Spine (Phila Pa 1976). 2000; 15: 1S-33S
- The Role of the thalamus in modulating pain.Malays J Med Sci. 2006; 13: 11-18
- Functional reorganization of the default mode network across chronic pain conditions.PLoS One. 2014; 9: e106133
Beck A, Steer RA, Brown GK, Beck depression inventory - II, 1996.
- Group comparison of resting-state FMRI data using multi-subject ICA and dual regression.Neuroimage. 2009; 47: 1
Bialosky JE, Beneciuk JM, Bishop MD, Coronado RA, Penza CW, Simon CB, George S: Unraveling the mechanisms of manual therapy: Modeling an approach. J Orthop Sports Phys Ther 48:8-18
Bialosky JE, Bishop MD, Robinson ME, Zeppieri G, George SZ: Spinal manipulative therapy has an immediate effect on thermal pain sensitivity in people with low back pain: A randomized controlled trial. Phys Ther 12:1292-1303
- Pain and analgesia: The value of salience circuits.Prog Neurobiol. 2013; 104: 93-105
- Motor thalamus integration of cortical, cerebellar and basal ganglia information: Implications for normal and parkinsonian conditions.Front Comput Neurosci. 2013; 7: 163
- Efficacy of spinal manipulation and mobilization for low back pain and neck pain: A systematic review and best evidence synthesis.Spine J. 2004; 4: 335-356
- Coding perceptual discrimination in the somatosensory thalamus.Proc Natl Acad Sci. 2012; 109: 21093-21098
- Role of the primary motor cortex in the maintenance and treatment of pain in fibromyalgia.Med Hypothesis. 2014; 83: 332-336
- An automated labeling system for subdividing the human cerebrral cortex on MRI scans into gyral based regions of interest.Neuroimage. 2006; 31: 968-980
- Brain mechanisms of anticipated painful movements and their modulation by manual therapy in chronic low back pain.J Pain. 2018; 19: 1352-1365
- The neural bases of emotion regulation.Nature Reviews: Neuroscience. 2015; 16: 693-700
- Immediate changes after manual therapy in resting-state functional connectivity as measured by functional magnetic resonance imaging in participants with induced low back pain.J Manipulative Physiol Ther. 2015; 37: 614-627
- Acute and chronic pain processing in the thalamocortical system of humans and animal models.Neuroscience. 2018; 1: 58-71
- Maitland's Vertebral Manipulation: Management of Neuromusculoskeletal Disorders.Churchill Livingstone, Elsevier, London, UK2014
- A new parcellation of the human thalamus on the basis of histochemical staining.Brain Res Brain Res Rev. 1989; 14: 1-34
- The parietal operculum preferentially encodes heat pain and not salience.PLoS Biol. 1989;
- The global burden of low back pain: estimates from the Global Burden of Disease 2010 study.Ann Rheum Dis. 2014; 73: 968-974
- Brain structural and psychometric alterations in chronic low back pain.Eur Spine J. 2013; 22: 1958-1964
- Napadow V: Somatotopically-specific primary somatosensory connectivity to salience and default mode networks encodes clinical pain.Pain. 2019; 160: 1594-1605
- Sensory, motor and intrinsic mechanisms of thalamic activity related to organic and psychogenic dystonia.J Alzheimers Dis Parkinsonism. 2017; 7: 324
- Thalamic sensory strokes with and without pain: Differences in lesion patterns in the vental posterior thalamus.J Neurol Neurosurg Psychiatry. 2012; 83: 776-784
- Napadow V: Machine learning-based prediction of clinical pain using multimodal neuroimaging and autonomic metrics.Pain. 2019; 160: 550-560
- The lateral prefrontal cortex mediates the hyperalgesic effects of negative cognitions in chronic pain patients.J Pain. 2015; 16: 692-699
- Default mode network connectivity encodes clinical pain: An arterial spin labeling study.Pain. 2013; 154: 24-33
- Cost-benefit and cost-effectiveness analysis of a disability prevention model for back pain management: A six year follow up study.Occup Environ Med. 2002; 59: 807-815
- Maitland's Vertebral Manipulation. 1. Elsevier, 2014
- Interactions between pain and the motor cortex: Insights from research on phatom limb pain and complex regional pain syndrome.Physiother Can. 2011; 63: 305-314
- Multiarchitectonic and stereaotactic atlas of the human thalamus.J Comp Neurol. 1997; 387: 588-630
- Decreased intrinsic brain connectivity is associated with reduced clinical pain in fibromyalgia.Arthritis & Rheumatism. 2012; 64: 2398-2403
- Intrinsic brain connectivity in fibromyalgia is associated with chronic pain intensity.Arthritis & Rheumatism. 2010; 62: 2545-2555
- Inhibition of mediodorsal thalamus disrupts thalmofrontal connectivity and cognition.Neuron. 2013; 77: 1151-1162
Penza CW, Horn ME, George SZ, Bishop D: Comparison of two lumbar manual therapies on temporal summation of pain in healthy volunteers. J Pain 18:1397-1408
- Spinal manipulative therapy and somatosensory activation.J Electromyogr Kinesiol. 2012; 22: 785-794
- Brain mechanisms of pain affect and pain modulation.Curr Opin Neurobiol. 2002; 12: 195-204
- Complementary and alternative medicine use by primary care patients with chronic pain.Pain Med. 2008; 9: 1065-1072
- Individual differences in the effects of perceived controllability on pain perception: Critical role of the prefrontal cortex.J Cogn Neurosci. 2007; 19: 993-1003
- Dissociable intrinsic connectivity networks for salience processing and executive control.J Neurosci. 2007; 27: 2349-2356
- Effective treatment of chronic low back pain in humans reverses abormal brain anatomy ad function.J. Neurosci. 2011; 31: 7540-7550
- Tactile representation in somatosensory thalamus (VPL) and cortex (S1) of awake primate and the pasticity induced by VPL neuroprosthetic stimulation.Brain Res. 2015; 2 (301-213)
- Using functional magnetic resonance imaging to determine if cerebral hemodynamic responses to pain change following thoracic spine thrust manipulation in healthy individuals.J Orthop Sports Phys Ther. 2013; 43: 340-348
- The pain catastrophizing scale: Development and validation.Psychol Assess. 1995; 7: 524-532
Tan G, Jensen MP, Thornby JI, Shanti BF: Validation of the brief pain inventory for chronic nonmalignant pain. J Pain 5:133-137
- Dissociation of Spatial-, Object-, and Sound-Coding neurons in the mediodorsal nucleus of the primate thalamus.Neurophysiol. 2003; 89
- United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: Effectiveness of physical treatments for back pain in primary care.BMJ. 2004;
- Reorganization of the motor cortex is associated with postural control deficits in recurrent low back pain.Brain. 2008; 131: 2161-2171
- Neural correlates of chronic low back pain measured by arterial spin labeling.Anesthesiology. 2011; 115: 364-374
- Anterolateral prefrontal cortex mediates the analgesic effect of expected and perceived control over pain.J Neurosc. 2006; 26: 11501-11509
- Psychological response in spinal manipulation (PRISM): A systematic review of psychological outcomes in randomised controlled trials.Complement Ther Med. 2007; 15: 271-283
- The organization of the human cerebral cortex estimated by intrinsic functional connectivity.J Neurophysiol. 2011; 106: 1125-1165
Article info
Publication history
Published online: December 11, 2020
Accepted:
November 24,
2020
Received in revised form:
October 29,
2020
Received:
June 22,
2020
Footnotes
V.N. and N.K. contributed equally to publication.None of the authors have any conflicts of interest to declare.
This research was supported by the NCMIC Foundation, Inc. (M.L.L.), Norwegian Research Council / Marie Sklodowska-Curie Actions (FRICON/COFUND – 240553/F20 to D.M.E.), the National Center for Research Resources (P41RR14075; CRC 1 UL 1 RR025758, Harvard Clinical and Translational Science Center); Martinos Computing facilities; NIH S10RR023401; S10RR019307; S10RR019254; S10RR023043.
Identification
Copyright
© 2020 by United States Association for the Study of Pain, Inc.
