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rTMS Pain Reduction Effectiveness in Non-specific Chronic Low Back Pain Patients using rs-fMRI Functional Connectivity

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Abstract

Purpose

Non-specific chronic low back pain (CLBP) is the most common form of CLBP without clear clinical evidence. This study evaluated the effectiveness of repetitive transcranial magnetic stimulation (rTMS) as a noninvasive technique for pain reduction in non-specific CLBP using functional connectivity (FC) method.

Methods

Fifteen participants with non-specific CLBP received 20 Hz rTMS over the motor cortex. The pain intensity was measured using a Visual Analog Scale (VAS), and brain functional scans were obtained before and after brain stimulation. The percentage pain reduction (PPR%) and the FC differences in the insula (INS), thalamus (THA), supplementary motor area (SMA), and anterior cingulate cortex (ACC) were determined using paired t-test analysis. The correlation between PPR% and FCs was explored using the Pearson correlation coefficient.

Results

Pain intensity reduced significantly after rTMS (P < 0.05). FC between bilateral SMA and ACC, and bilateral INS decreased while the FC between bilateral INS and bilateral THA increased following rTMS. Moreover, there was a negative correlation between the FC of INS (R)-SMA (R) and that of PPR% (r=-0.56).

Conclusion

FC between SMA and INS was associated with analgesia of rTMS in non-specific CLBP, indicating the potential role of FC as a novel objective parameter to predict the outcome of clinical use of rTMS for pain relief in CLBP patients.

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Acknowledgements

The authors thank with grateful appreciation for technical support by the staffs in National Brain Mapping Lab (NBML), Tehran, Iran. This study was part of the Ph.D thesis of Mahboubeh Masoumbeigi.

Funding

The research leading to these results received funding from research chancellor of Tehran University of Medical Sciences (TUMS) Tehran, Iran (Grant number: 97-03-30-40194).

Author information

Authors and Affiliations

  1. Medical Physics and Biomedical Engineering Department, School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran

    Mahboubeh Masoumbeigi, Nader Riyahi Alam, Amir Homayoun Jafari & Mahsa Kavousi

  2. PERFORM Preventive Medicine and Health Care Centre, Concordia University, 3 Rue Harbridge, Dollared Des Ormeaux (D. D. O.), Montreal, Quebec, Canada

    Nader Riyahi Alam

  3. Sports Medicine Department, School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran

    Ramin Kordi & Mohadeseh Yadollahi

  4. Sport Medicine Research Center, Neuroscience institute, Tehran University of Medical Sciences (TUMS), Tehran, Iran

    Ramin Kordi

  5. Neurosurgery Department, School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran

    Mohsen Rostami

  6. Spine Center of Excellence, Yas Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran

    Mohsen Rostami

  7. Neurology Department, School of Medicine, Yas Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran

    Mahdieh Afzali

  8. Epidemiology and Biostatistics Department, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran

    Abbas Rahimiforoushani

  9. Radiology Department, School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran

    Hasan Hashemi

Authors
  1. Mahboubeh Masoumbeigi
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  2. Nader Riyahi Alam
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  9. Hasan Hashemi
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  10. Mahsa Kavousi
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Contributions

Mahboubeh Masoumbeigi performed the data acquisition, fMRI analysis, interpretation of data, and drafting the work as the principal author. Nader Riyahi Alam designed the main conception of this work and approved the final version to be published. Ramin Kordi, Mohsen Rostami, Mahdieh Afzali, and Mohadeseh Yadollahi contributed to the recruitment and clinical assessment of the patients. Abbas Rahimi foroushani analyzed the results statistically. Amir Homayoun Jafari and Hasan Hashemi revised the manuscript critically for important intellectual content. Mahsa Kavousi contributed to the data acquisition.

Corresponding author

Correspondence to Nader Riyahi Alam.

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Conflict of interest

The authors have no conflict of interest.

Ethical approval:

The protocol of the human study was approved by the local ethical committee, Tehran University of Medical Sciences (TUMS), Tehran, Iran (Approval number: IR.TUMS.MEDICINE.REC.1397.957).

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Masoumbeigi, M., Alam, N.R., Kordi, R. et al. rTMS Pain Reduction Effectiveness in Non-specific Chronic Low Back Pain Patients using rs-fMRI Functional Connectivity. J. Med. Biol. Eng. 42, 647–657 (2022). https://doi.org/10.1007/s40846-022-00721-8

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  • DOI: https://doi.org/10.1007/s40846-022-00721-8

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