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Li X, Meng F, Huang W, Cui Y, Meng F, Wu S, Xu H. The Alterations in the Brain Corresponding to Low Back Pain: Recent Insights and Advances. Neural Plast 2024; 2024:5599046. [PMID: 38529366 PMCID: PMC10963108 DOI: 10.1155/2024/5599046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 03/27/2024] Open
Abstract
Low back pain (LBP) is a leading cause of global disabilities. Numerous molecular, cellular, and anatomical factors are implicated in LBP. Current issues regarding neurologic alterations in LBP have focused on the reorganization of peripheral nerve and spinal cord, but neural mechanisms of exactly what LBP impacts on the brain required further researches. Based on existing clinical studies that chronic pain problems were accompanying alterations in brain structures and functions, researchers proposed logical conjectures that similar alterations occur in LBP patients as well. With recent extensive studies carried out using noninvasive neuroimaging technique, increasing number of abnormalities and alterations has been identified. Here, we reviewed brain alterations including white matters, grey matters, and neural circuits between brain areas, which are involved in chronic LBP. Moreover, brain structural and functional connectivity abnormalities are correlated to the happening and transition of LBP. The negative emotions related to back pain indicate possible alterations in emotional brain regions. Thus, the aim of this review is to summarize current findings on the alterations corresponding to LBP in the brain. It will not only further our understanding of etiology of LBP and understanding of negative emotions accompanying with back pain but also provide ideas and basis for new accesses to the diagnosis, treatment, and rehabilitation afterward based on integral medicine.
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Affiliation(s)
- Xuyang Li
- Department of Neurobiology and Collaborative Innovation Center for Brain Science, School of Basic Medicine, The Fourth Military Medical University, Xi'an, China
| | - Fancheng Meng
- Department of Neurobiology and Collaborative Innovation Center for Brain Science, School of Basic Medicine, The Fourth Military Medical University, Xi'an, China
| | - Wenye Huang
- Department of Neurobiology and Collaborative Innovation Center for Brain Science, School of Basic Medicine, The Fourth Military Medical University, Xi'an, China
- College of Life Sciences, Northwest University, Xi'an, China
| | - Yue Cui
- Department of Neurobiology and Collaborative Innovation Center for Brain Science, School of Basic Medicine, The Fourth Military Medical University, Xi'an, China
| | - Fanbo Meng
- Department of Neurobiology and Collaborative Innovation Center for Brain Science, School of Basic Medicine, The Fourth Military Medical University, Xi'an, China
| | - Shengxi Wu
- Department of Neurobiology and Collaborative Innovation Center for Brain Science, School of Basic Medicine, The Fourth Military Medical University, Xi'an, China
| | - Hui Xu
- Department of Neurobiology and Collaborative Innovation Center for Brain Science, School of Basic Medicine, The Fourth Military Medical University, Xi'an, China
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Kutafina E, Becker S, Namer B. Measuring pain and nociception: Through the glasses of a computational scientist. Transdisciplinary overview of methods. FRONTIERS IN NETWORK PHYSIOLOGY 2023; 3:1099282. [PMID: 36926544 PMCID: PMC10013045 DOI: 10.3389/fnetp.2023.1099282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/04/2023] [Indexed: 02/12/2023]
Abstract
In a healthy state, pain plays an important role in natural biofeedback loops and helps to detect and prevent potentially harmful stimuli and situations. However, pain can become chronic and as such a pathological condition, losing its informative and adaptive function. Efficient pain treatment remains a largely unmet clinical need. One promising route to improve the characterization of pain, and with that the potential for more effective pain therapies, is the integration of different data modalities through cutting edge computational methods. Using these methods, multiscale, complex, and network models of pain signaling can be created and utilized for the benefit of patients. Such models require collaborative work of experts from different research domains such as medicine, biology, physiology, psychology as well as mathematics and data science. Efficient work of collaborative teams requires developing of a common language and common level of understanding as a prerequisite. One of ways to meet this need is to provide easy to comprehend overviews of certain topics within the pain research domain. Here, we propose such an overview on the topic of pain assessment in humans for computational researchers. Quantifications related to pain are necessary for building computational models. However, as defined by the International Association of the Study of Pain (IASP), pain is a sensory and emotional experience and thus, it cannot be measured and quantified objectively. This results in a need for clear distinctions between nociception, pain and correlates of pain. Therefore, here we review methods to assess pain as a percept and nociception as a biological basis for this percept in humans, with the goal of creating a roadmap of modelling options.
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Affiliation(s)
- Ekaterina Kutafina
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Faculty of Applied Mathematics, AGH University of Science and Technology, Krakow, Poland
| | - Susanne Becker
- Clinical Psychology, Department of Experimental Psychology, Heinrich Heine University, Düsseldorf, Germany
- Integrative Spinal Research, Department of Chiropractic Medicine, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Barbara Namer
- Junior Research Group Neuroscience, Interdisciplinary Center for Clinical Research Within the Faculty of Medicine, RWTH Aachen University, Aachen, Germany
- Institute of Physiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
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3
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Mechanisms behind the Development of Chronic Low Back Pain and Its Neurodegenerative Features. LIFE (BASEL, SWITZERLAND) 2022; 13:life13010084. [PMID: 36676033 PMCID: PMC9862392 DOI: 10.3390/life13010084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/11/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
Abstract
Chronic back pain is complex and there is no guarantee that treating its potential causes will cause the pain to go away. Therefore, rather than attempting to "cure" chronic pain, many clinicians, caregivers and researchers aim to help educate patients about their pain and try to help them live a better quality of life despite their condition. A systematic review has demonstrated that patient education has a large effect on pain and pain related disability when done in conjunction with treatments. Therefore, understanding and updating our current state of knowledge of the pathophysiology of back pain is important in educating patients as well as guiding the development of novel therapeutics. Growing evidence suggests that back pain causes morphological changes in the central nervous system and that these changes have significant overlap with those seen in common neurodegenerative disorders. These similarities in mechanisms may explain the associations between chronic low back pain and cognitive decline and brain fog. The neurodegenerative underpinnings of chronic low back pain demonstrate a new layer of understanding for this condition, which may help inspire new strategies in pain education and management, as well as potentially improve current treatment.
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Jotwani ML, Wu Z, Lunde CE, Sieberg CB. The missing mechanistic link: Improving behavioral treatment efficacy for pediatric chronic pain. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 3:1022699. [PMID: 36313218 PMCID: PMC9614027 DOI: 10.3389/fpain.2022.1022699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022]
Abstract
Pediatric chronic pain is a significant global issue, with biopsychosocial factors contributing to the complexity of the condition. Studies have explored behavioral treatments for pediatric chronic pain, but these treatments have mixed efficacy for improving functional and psychological outcomes. Furthermore, the literature lacks an understanding of the biobehavioral mechanisms contributing to pediatric chronic pain treatment response. In this mini review, we focus on how neuroimaging has been used to identify biobehavioral mechanisms of different conditions and how this modality can be used in mechanistic clinical trials to identify markers of treatment response for pediatric chronic pain. We propose that mechanistic clinical trials, utilizing neuroimaging, are warranted to investigate how to optimize the efficacy of behavioral treatments for pediatric chronic pain patients across pain types and ages.
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Affiliation(s)
- Maya L. Jotwani
- Department of Psychiatry and Behavioral Sciences, Biobehavioral Pain Innovations Lab, Boston Children's Hospital, Boston, MA, United States,Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, Pain Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Ziyan Wu
- Department of Psychiatry and Behavioral Sciences, Biobehavioral Pain Innovations Lab, Boston Children's Hospital, Boston, MA, United States,Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, Pain Medicine, Boston Children's Hospital, Boston, MA, United States,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Claire E. Lunde
- Department of Psychiatry and Behavioral Sciences, Biobehavioral Pain Innovations Lab, Boston Children's Hospital, Boston, MA, United States,Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, Pain Medicine, Boston Children's Hospital, Boston, MA, United States,Nuffield Department of Women's and Reproductive Health, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Christine B. Sieberg
- Department of Psychiatry and Behavioral Sciences, Biobehavioral Pain Innovations Lab, Boston Children's Hospital, Boston, MA, United States,Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, Pain Medicine, Boston Children's Hospital, Boston, MA, United States,Department of Psychiatry, Harvard Medical School, Boston, MA, United States,Correspondence: Christine B. Sieberg
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Baran TM, Lin FV, Geha P. Functional brain mapping in patients with chronic back pain shows age-related differences. Pain 2022; 163:e917-e926. [PMID: 34799532 DOI: 10.1097/j.pain.0000000000002534] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 10/29/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Low back pain is the most common pain condition and cause for disability in older adults. Older adults suffering from low back pain are more disabled than their healthy peers, are more predisposed to frailty, and tend to be undertreated. The cause of increased prevalence and severity of this chronic pain condition in older adults is unknown. Here, we draw on accumulating data demonstrating a critical role for brain limbic and sensory circuitries in the emergence and experience of chronic low back pain (CLBP) and the availability of resting-state brain activity data collected at different sites to study how brain activity patterns predictive of CLBP differ between age groups. We apply a data-driven multivariate searchlight analysis to amplitude of low-frequency fluctuation brain maps to classify patients with CLBP with >70% accuracy. We observe that the brain activity pattern including the paracingulate gyrus, insula/secondary somatosensory area, inferior frontal, temporal, and fusiform gyrus predicted CLBP. When separated by age groups, brain patterns predictive of older patients with CLBP showed extensive involvement of limbic brain areas including the ventromedial prefrontal cortex, the nucleus accumbens, and hippocampus, whereas only anterior insula paracingulate and fusiform gyrus predicted CLBP in the younger patients. In addition, we validated the relationships between back pain intensity ratings and CLBP brain activity patterns in an independent data set not included in our initial patterns' identification. Our results are the first to directly address how aging affects the neural signature of CLBP and point to an increased role of limbic brain areas in older patients with CLBP.
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Affiliation(s)
- Timothy M Baran
- Department of Imaging Sciences, University of Rochester, Rochester, NY, United States
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States
| | - Feng V Lin
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
- Department of Brain and Cognitive Sciences, University of Rochester, Rochester, NY, United States
| | - Paul Geha
- Department of Neuroscience, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States
- Department of Neurology, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States
- Department of Psychiatry, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States
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Sitges C, Terrasa JL, García-Dopico N, Segur-Ferrer J, Velasco-Roldán O, Crespí-Palmer J, González-Roldán AM, Montoya P. An Educational and Exercise Mobile Phone–Based Intervention to Elicit Electrophysiological Changes and to Improve Psychological Functioning in Adults With Nonspecific Chronic Low Back Pain (BackFit App): Nonrandomized Clinical Trial. JMIR Mhealth Uhealth 2022; 10:e29171. [PMID: 35289758 PMCID: PMC8965676 DOI: 10.2196/29171] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/28/2021] [Accepted: 01/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Concomitant psychological and cognitive impairments modulate nociceptive processing and contribute to chronic low back pain (CLBP) maintenance, poorly correlated with radiological findings. Clinical practice guidelines recommend self-management and multidisciplinary educational and exercise-based interventions. However, these recommendations are based on self-reported measurements, which lack evidence of related electrophysiological changes. Furthermore, current mobile health (mHealth) tools for self-management are of low quality and scarce evidence. Thus, it is necessary to increase knowledge on mHealth and electrophysiological changes elicited by current evidence-based interventions.
Objective
The aim of this study is to investigate changes elicited by a self-managed educational and exercise-based 4-week mHealth intervention (BackFit app) in electroencephalographic and electrocardiographic activity, pressure pain thresholds (PPTs), pain, disability, and psychological and cognitive functioning in CLBP versus the same intervention in a face-to-face modality.
Methods
A 2-arm parallel nonrandomized clinical trial was conducted at the University of the Balearic Islands (Palma, Spain). A total of 50 patients with nonspecific CLBP were assigned to a self-managed group (23/50, 46%; mean age 45.00, SD 9.13 years; 10/23, 43% men) or a face-to-face group (27/50, 54%; mean age 48.63, SD 7.54 years; 7/27, 26% men). The primary outcomes were electroencephalographic activity (at rest and during a modified version of the Eriksen flanker task) and heart rate variability (at rest), PPTs, and pressure pain intensity ratings. The secondary outcomes were pain, disability, psychological functioning (mood, anxiety, kinesiophobia, pain catastrophizing, and fear-avoidance beliefs), and cognitive performance (percentage of hits and reaction times).
Results
After the intervention, frequency analysis of electroencephalographic resting-state data showed increased beta-2 (16-23 Hz; 0.0020 vs 0.0024; P=.02) and beta-3 (23-30 Hz; 0.0013 vs 0.0018; P=.03) activity. In addition, source analyses revealed higher power density of beta (16-30 Hz) at the anterior cingulate cortex and alpha (8-12 Hz) at the postcentral gyrus and lower power density of delta (2-4 Hz) at the cuneus and precuneus. Both groups also improved depression (7.74 vs 5.15; P=.01), kinesiophobia (22.91 vs 20.87; P=.002), activity avoidance (14.49 vs 12.86; P<.001), helplessness (6.38 vs 4.74; P=.02), fear-avoidance beliefs (35 vs 29.11; P=.03), and avoidance of physical activity (12.07 vs 9.28; P=.01) scores, but there was an increase in the disability score (6.08 vs 7.5; P=.01). No significant differences between the groups or sessions were found in heart rate variability resting-state data, electroencephalographic data from the Eriksen flanker task, PPTs, subjective ratings, or cognitive performance.
Conclusions
Both intervention modalities increased mainly beta activity at rest and improved psychological functioning. Given the limitations of our study, conclusions must be drawn carefully and further research will be needed. Nevertheless, to the best of our knowledge, this is the first study reporting electroencephalographic changes in patients with CLBP after an mHealth intervention.
Trial Registration
ClinicalTrials.gov NCT04576611; https://clinicaltrials.gov/ct2/show/NCT04576611
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Affiliation(s)
- Carolina Sitges
- Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), Department of Psychology, University of the Balearic Islands (UIB), Palma, Spain
| | - Juan L Terrasa
- Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), Department of Psychology, University of the Balearic Islands (UIB), Palma, Spain
| | - Nuria García-Dopico
- Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Palma, Spain
| | - Joan Segur-Ferrer
- Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), University of the Balearic Islands (UIB), Palma, Spain
| | - Olga Velasco-Roldán
- Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Palma, Spain
| | - Jaume Crespí-Palmer
- Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), University of the Balearic Islands (UIB), Palma, Spain
| | - Ana María González-Roldán
- Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), Department of Psychology, University of the Balearic Islands (UIB), Palma, Spain
| | - Pedro Montoya
- Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), Department of Psychology, University of the Balearic Islands (UIB), Palma, Spain
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Watching Your Neck: The Influence of Real-Time Visual Feedback on Cervical Joint Position Sense in Chronic Neck Pain. Motor Control 2021; 25:631-643. [PMID: 34510021 DOI: 10.1123/mc.2019-0111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 04/30/2021] [Accepted: 07/06/2021] [Indexed: 11/18/2022]
Abstract
Patients with neck pain demonstrate a variety of sensorimotor impairments, such as decreased cervical joint position sense (CJPS) acuity, which might also be associated with an impaired internal body representation. The present study evaluated the effect of real-time visual feedback of the individual's own neck on CJPS compared to observing a book. Twenty-three patients with neck pain participated in the experiment and received the interventions in randomized order on separate days in a within-subject pretest-posttest design. Before and immediately after each intervention, CJPS was measured by a therapist blinded to the intervention. The results demonstrate a significantly different development of CJPS (p = .04), with increased CJPS acuity after observing one's own neck and decreased acuity after observing a book. Real-time visual feedback of the neck improved CJPS acuity in patients with neck pain without active movements of the neck, indicating the importance of central nervous system processing for CJPS acuity.
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McPhee ME, Graven-Nielsen T. Medial Prefrontal High-Definition Transcranial Direct Current Stimulation to Improve Pain Modulation in Chronic Low Back Pain: A Pilot Randomized Double-blinded Placebo-Controlled Crossover Trial. THE JOURNAL OF PAIN 2021; 22:952-967. [PMID: 33676009 DOI: 10.1016/j.jpain.2021.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/09/2021] [Accepted: 02/19/2021] [Indexed: 06/12/2023]
Abstract
Chronic low back pain (CLBP) is highly disabling, but often without identifiable source. Focus has been on impaired anti-nociceptive mechanisms contributing to pain maintenance, though methods of targeting this impairment remain limited. This randomised-controlled cross-over pilot trial used active versus sham medial prefrontal cortex (mPFC) high-definition transcranial direct current stimulation (HD-tDCS) for 3-consecutive days to improve descending pain inhibitory function. Twelve CLBP patients were included with an average visual analogue scale (VAS) pain intensity of 3.0 ± 1.5 and pain duration of 5.3 ± 2.6 years. Pressure pain thresholds (PPTs), conditioned pain modulation (CPM), and temporal summation of pain (TSP) assessed by cuff algometry, as well as pain symptomatology (intensity, unpleasantness, quality, disability) and related psychological features (pain catastrophizing, anxiety, affect), were assessed on Day1 before 3 consecutive days of HD-tDCS sessions (each 20 minutes), at 24-hours (Day 4) and 2-weeks (Day 21) following final HD-tDCS. Blinding was successful. No significant differences in psychophysical (PPT, CPM, TSP), symptomatology or psychological outcomes were observed between active and sham HD-tDCS on Day4 and Day21. CPM-effects at Day 1 negatively correlated with change in CPM-effect at Day4 following active HD-tDCS (P = .002). Lack of efficacy was attributed to several factors, not least that patients did not display impaired CPM at baseline. TRIAL REGISTRATION: : ClinicalTrials.gov (NCT03864822). PERSPECTIVE: Medial prefrontal HD-tDCS did not alter pain, psychological nor psychophysical outcomes, though correlational analysis suggested response may depend on baseline pain inhibitory efficacy, with best potential effects in patients with severe impairments in descending pain inhibitory mechanisms. Future work should focus on appropriate patient selection and optimising stimulation targeting.
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Affiliation(s)
- Megan E McPhee
- Center for Neuroplasticity and Pain (CNAP), Aalborg University, Denmark
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9
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Incidence and Risk Factors of Low Back Pain in Marathon Runners. Pain Res Manag 2021; 2021:6660304. [PMID: 33688384 PMCID: PMC7920723 DOI: 10.1155/2021/6660304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 01/27/2021] [Accepted: 02/11/2021] [Indexed: 12/15/2022]
Abstract
Purpose The occurrence of low back pain (LBP) in marathon runners has been poorly understood. This study aimed to describe the risk factors and identify whether these factors can cause LBP in these athletes. Methods A self-developed questionnaire was randomly distributed to 850 runners of running a half or a full marathon. Participants responded with the questionnaire focusing on previous training and running conditions after their competitions. Results On the basis of the remaining 800 valid questionnaires, the incidence of LBP was 4.50% (n = 36). A total of 572 (71.5%) males and 228 (28.5%) females, with an average age range of 33.9 ± 9.0 years, came from different occupations with different physical activity characteristics. However, no significant associations between occupation and runners with LBP (p > 0.05) were found. In the final models, risk factors, including warm-up activities (p=0.012, OR = 2.617), fatigue (p = 0.008, OR = 2.680), running gait posture (p=0.041, OR = 2.273), and environmental temperature (p=0.020, OR = 6.584), were significantly associated with LBP in marathoners. Conclusion Although LBP was uncommon in marathoners, it was linked to the factors such as insufficient warm-up activities, fatigue, poor running gait posture, and uncomfortable environmental temperature. Future studies need to validate these results. Nevertheless, these findings could still be useful for protecting the lower back area of runners clinically.
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10
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Tu Y, Cao J, Bi Y, Hu L. Magnetic resonance imaging for chronic pain: diagnosis, manipulation, and biomarkers. SCIENCE CHINA-LIFE SCIENCES 2020; 64:879-896. [PMID: 33247802 DOI: 10.1007/s11427-020-1822-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/15/2020] [Indexed: 12/16/2022]
Abstract
Pain is a multidimensional subjective experience with biological, psychological, and social factors. Whereas acute pain can be a warning signal for the body to avoid excessive injury, long-term and ongoing pain may be developed as chronic pain. There are more than 100 million people in China living with chronic pain, which has raised a huge socioeconomic burden. Studying the mechanisms of pain and developing effective analgesia approaches are important for basic and clinical research. Recently, with the development of brain imaging and data analytical approaches, the neural mechanisms of chronic pain have been widely studied. In the first part of this review, we briefly introduced the magnetic resonance imaging and conventional analytical approaches for brain imaging data. Then, we reviewed brain alterations caused by several chronic pain disorders, including localized and widespread primary pain, primary headaches and orofacial pain, musculoskeletal pain, and neuropathic pain, and present meta-analytical results to show brain regions associated with the pathophysiology of chronic pain. Next, we reviewed brain changes induced by pain interventions, such as pharmacotherapy, neuromodulation, and acupuncture. Lastly, we reviewed emerging studies that combined advanced machine learning and neuroimaging techniques to identify diagnostic, prognostic, and predictive biomarkers in chronic pain patients.
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Affiliation(s)
- Yiheng Tu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100101, China
| | - Jin Cao
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, 02129, USA
| | - Yanzhi Bi
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100101, China
| | - Li Hu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, China. .,Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100101, China. .,Department of Pain Management, The State Key Clinical Specialty in Pain Medicine, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, China.
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11
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Mokhtari T, Tu Y, Hu L. Involvement of the hippocampus in chronic pain and depression. BRAIN SCIENCE ADVANCES 2020. [DOI: 10.26599/bsa.2019.9050025] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Increases in depressive behaviors have been reported in patients experiencing chronic pain. In these patients, the symptoms of pain and depression commonly coexist, impairing their lives and challenging effective treatment. The hippocampus may play a role in both chronic pain and depression. A reduction in the volume of the hippocampus is related to reduced neurogenesis and neuroplasticity in cases of chronic pain and depression. Moreover, an increase of proinflammatory factors and a reduction of neurotrophic factors have been reported to modulate the hippocampal neurogenesis and neuroplasticity in chronic pain and depression. This review discusses the mechanisms underlying the depressive-like behavior accompanying chronic pain, emphasizing the structural and functional changes in the hippocampus. We also discuss the hypothesis that pro-inflammatory factors and neurotrophic factors expressed in the hippocampus may serve as a therapeutic target for comorbid chronic pain and depression.
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Affiliation(s)
- Tahmineh Mokhtari
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing 100101, China
| | - Yiheng Tu
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Li Hu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing 100101, China
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