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The effect of spinal manipulation on brain neurometabolites in chronic nonspecific low back pain patients: a randomized clinical trial

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Abstract

Background

In patients with chronic nonspecific low back pain (NCLBP), brain function changes due to the neuroplastic changes in different regions.

Aim

The current study aimed to evaluate the brain metabolite changes after spinal manipulation, using proton magnetic resonance spectroscopy (1H-MRS).

Methods

In the current study, 25 patients with NCLBP aged 20–50 years were enrolled. Patients were randomly assigned to lumbopelvic manipulation or sham. Patients were evaluated before and 5 weeks after treatment by the Numerical Rating Scale (NRS), the Oswestry Disability Index (ODI), and 1H-MRS.

Results

After treatment, severity of pain and functional disability were significantly reduced in the treatment group vs. sham group (p < 0.05). After treatment, N-acetyl aspartate (NAA) in thalamus, insula, dorsolateral prefrontal cortex (DLPFC) regions, as well as choline (Cho) in the thalamus, insula, and somatosensory cortex (SSC) regions, had increased significantly in the treatment group compared with the sham group (p < 0.05). A significant increase was further observed in NAA in thalamus, anterior cingulate cortex (ACC), and SCC regions along with Cho metabolite in thalamus and SCC regions after treatment in the treatment group compared with the baseline measures (p < 0.05). Also, a significant increase was observed in Glx (glutamate and glutamine) levels of thalamus (p = 0.03). There was no significant difference in terms of brain metabolites at baseline and after treatment in the sham group.

Conclusion

In the patient with low back pain, spinal manipulation affects the central nervous system and changes the brain metabolites. Consequently, pain and functional disability are reduced.

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Acknowledgments

This article was extracted from the Physiotherapy Ph.D. thesis (1396-01-06-14881) from Shiraz University of Medical Sciences. The authors wish to thank Mr. H. Argasi at the Research Consultation Center (RCC) of Shiraz University of Medical Sciences for his invaluable assistance in editing this manuscript.

Author information

Authors and Affiliations

  1. Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran

    Daryoush Didehdar, Fahimeh Kamali & Amin Kordi Yoosefinejad

  2. Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

    Fahimeh Kamali & Amin Kordi Yoosefinejad

  3. Medical Imaging Research Center and Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran

    Mehrzad Lotfi

Authors
  1. Daryoush Didehdar
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  2. Fahimeh Kamali
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  3. Amin Kordi Yoosefinejad
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  4. Mehrzad Lotfi
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Contributions

All authors designed the study. Daryoush Didehdar collected and analyzed the data. All authors discussed the results and commented on the manuscript. All authors have carefully read and reviewed the manuscript.

Corresponding author

Correspondence to Fahimeh Kamali.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethics Committee of Shiraz University of Medical Sciences (IR.SUMS.REC.1396.139) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Didehdar, D., Kamali, F., Yoosefinejad, A.K. et al. The effect of spinal manipulation on brain neurometabolites in chronic nonspecific low back pain patients: a randomized clinical trial. Ir J Med Sci 189, 543–550 (2020). https://doi.org/10.1007/s11845-019-02140-2

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  • DOI: https://doi.org/10.1007/s11845-019-02140-2

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