[1]谭文莉 王炜 姜宏宁 曾科 杨玉婵 陈义磊 黄炎文 王辉 龚志刚 詹松华 王建伟△.推拿治疗慢性下腰痛的即时脑效应研究[J].中国中医骨伤科杂志,2019,27(01):11-16.
　TAN Wenli WANG Wei JIANG Hongning ZENG Ke YANG Yuchan CHEN Yilei HUANG Yanwen WANG Hui GONG Zhigang ZHAN Songhua WANG Jianwei.Brain Immediate Analgesia Mechanism of Tuina in Low Back Pain[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2019,27(01):11-16.
点击复制

推拿治疗慢性下腰痛的即时脑效应研究()
分享到：

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第27卷
期数:
2019年01期
页码:
11-16
栏目:
临床研究
出版日期:
2019-01-15

文章信息/Info

Title:
Brain Immediate Analgesia Mechanism of Tuina in Low Back Pain
文章编号:
1005-0205(2019)01-0011-06
作者:
谭文莉1 王炜2 姜宏宁1 曾科2 杨玉婵1 陈义磊1 黄炎文1 王辉1 龚志刚1 詹松华1 王建伟2△
1上海中医药大学附属曙光医院放射科(上海,200021) 2上海中医药大学附属曙光医院推拿科
Author(s):
TAN Wenli1 WANG Wei2 JIANG Hongning1 ZENG Ke2 YANG Yuchan1 CHEN Yilei1 HUANG Yanwen1 WANG Hui1 GONG Zhigang1 ZHAN Songhua1 WANG Jianwei2△
Shuguang Hospital, Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200021, China.
关键词:
慢性下腰痛;  椎间盘突出症;  脊柱推拿手法治疗;  血氧水平依赖功能磁共振成像
Keywords:
low back pain;  intervertebral disc herniation;  spinal Tuina therapy;  blood-oxygen-level dependent functional magnetic resonance imaging
分类号:
R681.5
文献标志码:
A
摘要:
通过静息态血氧水平依赖功能磁共振成像(BOLD fMRI)探讨推拿缓解慢性下腰痛的即时镇痛效应。方法:前瞻性收集20例慢性下腰痛受试者接受推拿治疗,在治疗前后即刻分别进行静息态BOLD fMRI检查。同时募集20例性别年龄匹配健康志愿者,比较慢性下腰痛受试者治疗前后与健康志愿者低频振幅值(ALFF)的差异,并将ALFF值与各项临床评分进行相关性分析。结果:慢性下腰痛受试者治疗前疼痛视觉模拟评分(VAS)及改良Oswestry功能障碍指数(ODI)分别为(53.25±14.26)分,(30.10±12.73)分,治疗后分别为(31.00±10.71)分,(21.45±9.85)分,差异有统计学意义(P<0.05)。慢性下腰痛受试者与健康志愿者比较出现右侧后扣带回、额上回ALFF值的升高及左侧辅助运动区ALFF值的降低。治疗后与健康志愿者比较,右侧楔前叶脑功能活动减低。推拿治疗后与之前比较,慢性下腰痛受试者小脑后叶ALFF值升高,两侧额中回、右侧扣带回、右侧角回ALFF值减低。在慢性下腰痛受试者治疗前后的配对t检验中,右侧额中回的ALFF值与VAS和ODI变化率负相关。结论:推拿的即时镇痛效应体现在纠正疼痛矩阵相关脑区的异常改变,同时又引起认知相关区域的变化。
Abstract:
To explore the immediate analgesia mechanism of Tuina in low back pain through the rest blood-oxygen-level dependent functional magnetic resonance imaging(BOLD fMRI). Methods: Twenty patients with low back pain were recruited for Tuina therapy and the rest BOLD fMRI were performed before and right after the therapy. Meanwhile twenty volunteers who were age-and gender-matched with the patients were recruited and the rest BOLD fMRI were performed once. The difference of amplitude of low frequency fluctuation(ALFF)was calculated between the patients before therapy and volunteers, between the patients after therapy and volunteers, and between the patients before and after Tuina. The correlation analysis of ALFF value and clinical indexes was calculated. Results: The visual analogue scale(VAS)and modified Oswestry disability index(ODI)of patients were(53.25 ± 14.26)and(30.10±12.73). After the therapy, they were changed into(31.00±10.71),(21.45± 9.85). There was significant statistical difference. Compared to volunteers, the patients showed higher ALFF value in the right posterior cingulate, superior frontal gyrus and lower ALFF value in the left supplementary motor area. After the Tuina, the patients showed lower brain activity in the right precuneus. The left and right middle frontal gyrus, right cingulate gyrus, right angular gyrus showed lower ALFF value, and the posterior lobe of cerebellum showed higher ALFF value in the patients after Tuina, compared to them without Tuina. In the paired t-test of patients, the ALFF value of the right middle frontal gyrus was negatively correlated with the changes of VAS and modified ODI. Conclusion: The immediate analgesia effect of Tuina is embodied in rectifying the abnormal changes in the pain matrix and bringing the changes of brain cognitive area.

参考文献/References:

[1] KONG L J,FANG M,ZHAN H S,et al.Tuina-focused integrative chinese medical therapies for inpatients with low back pain:a systematic review and meta-analysis[J].Evid Based Complement Alternat Med,2012:578305.
[2] BURTON A K,BALAGUÉ F,CARDON G,et al.Chapter 2.European guidelines for prevention in low back pain:November 2004[J].Eur Spine J,2006,15(2):136-168.
[3] MELZACK R.Pain and the neuromatrix in the brain[J].J Dent Educ,2001,65(12):1378-1382.
[4] KULKARNI B,BENTLEY D E,ELLIOTT R,et al.Attention to pain localization and unpleasantness discriminates the functions of the medial and lateral pain systems[J].Eur J Neurosci,2005,21(11):3133-3142.
[5] BUSHNELL M C,CEKO M,LOW L A.Cognitive and emotional control of pain and its disruption in chronic pain[J].Nat Rev Neurosci,2013,14(7):502-511.
[6] LUMLEY M A,COHEN J L,BORSZCZ G S,et al.Pain and emotion:a biopsychosocial review of recent research[J].J Clin Psychol,2011,67(9):942-968.
[7] BERNA C,LEKNES S,HOLMES E A,et al.Induction of depressed mood disrupts emotion regulation neurocircuitry and enhances pain unpleasantness[J].Biol Psychiatry,2010,67(11):1083-1090.
[8] KONNO S I,SEKIGUCHI M.Association between brain and low back pain[J].J Orthop Sci,2018,3(1):3-7.
[9] LEE K M,CHANG K H,ROH J K.Subregions within the supplementary motor area activated at different stages of movement preparation and execution[J].Neuroimage,1999,9(1):117-123.
[10] SUMNER P,NACHEV P,MORRIS P,et al.Human medial frontal cortex mediates unconscious inhibition of voluntary action[J].Neuron,2007,54(5):697-711.
[11] ZHOU F,GU L,HONG S,et al.Altered low-frequency oscillation amplitude of resting state-fMRI in patients with discogenic low-back and leg pain[J].J Pain Res,2018,11:165-176.
[12] BALIKI M N,GEHA P Y,JABAKHANJI R,et al.A preliminary fMRI study of analgesic treatment in chronic back pain and knee osteoarthritis[J].Mol Pain,2008,4(1):47.
[13] CEKO M,SHIR Y,OUELLET J A,et al.Partial recovery of abnormal insula and dorsolateral prefrontal connectivity to cognitive networks in chronic low back pain after treatment[J].Hum Brain Mapp,2015,36(6):2075-2092.
[14] 靳静,董峰,唐一源.探测静息状态大脑活动的关键区域[J].自然科学进展,2007,17(5):678-682.
[15] CAVANNA A E,TRIMBLE M R.The precuneus:a review of its functional anatomy and behavioural correlates[J].Brain,2006,129(Pt 3):564-583.
[16] CABEZA R,NYBERG L.Imaging cognition Ⅱ:an empirical review of 275 PET and fMRI studies[J].J Cogn Neurosci,2000,12(1):1-47.
[17] KONG J,LOGGIA M L,ZYLONEY C,et al.Exploring the brain in pain:activations,deactivations and their relation[J].Pain,2010,148(2):257-267.
[18] GILBOA A,WINOCUR G,GRADY C L,et al.Remembering our past:functional neuroanatomy of recollection of recent and very remote personal events[J].Cereb Cortex,2004,14(11):1214-1225.

备注/Memo

备注/Memo:
基金项目:国家自然科学基金项目(81503595) 上海市科学技术委员会科研项目(17441902600, 18401970300) 上海中医药大学杏林中青年人才培养项目-杏林学者 1上海中医药大学附属曙光医院放射科(上海,200021) 2上海中医药大学附属曙光医院推拿科 △通信作者 E-mail:wq_1973@163.com
更新日期/Last Update: 2019-01-15