Impact of Intermittent Theta Burst Stimulation on Pain Relief and Brain Connectivity in Chronic Low Back Pain

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain Pub Date : 2025-05-05 DOI:10.1002/ejp.70033

Jiajia Yang, Xiaoyu Gao, Xue Cheng, Ruochen Fu, Hao Xie, Siyun Zhang, Zhenwen Liang, Xi Chen, Qiuhua Yu, Chuhuai Wang

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引用次数: 0

Abstract

Background

This randomised clinical trial investigated the effect of intermittent theta burst stimulation (iTBS) over the dorsolateral prefrontal cortex (DLPFC) on pain alleviation in patients with chronic low back pain (CLBP) and its underlying mechanisms.

Methods

Forty CLBP patients were randomly assigned to receive either active or sham iTBS combined with core stability exercise. Pain assessments were completed before and after the intervention. Eleven patients from each group underwent resting-state functional magnetic resonance imaging scans pre- and post-intervention to analyse DLPFC activation and connectivity with other brain regions.

Results

The active iTBS group had a greater pain reduction than the sham group (p = 0.05, 95% CI: −0.009 to 1.109). In the active and sham groups, 80% (16/20) and 40% (8/20) reached the minimal clinically important difference, respectively, with a number needed to treat of 2.5. For the Fear-Avoidance Beliefs Questionnaire, there was a significant difference between the two groups (p = 0.011, r = 0.40). The active iTBS group showed a significantly enhanced functional connectivity between the left DLPFC and the right cerebellum, as well as both occipital gyri (voxel-level, p < 0.001; cluster-level familywise error rate, p < 0.01). Spearman's correlation analysis showed a significant negative correlation between Numerical Rating Scale and the FC of the left DLPFC and the right cerebellum (rho = −0.55, p = 0.008), the right (rho = −0.439, p = 0.01), and left occipital gyri (rho = −0.45, p = 0.034).

Conclusion

iTBS may alleviate pain in CLBP patients by enhancing DLPFC connectivity with the cerebellum and occipital gyrus.

Significance

This study showed a facilitatory effect of iTBS on alleviating CLBP, which might be modulated by brain functional connectivity.

Trial Registration

Chinese Clinical Trial Registry: ChiCTR2200064899

Abstract Image

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间歇性θ波爆发刺激对慢性腰痛患者疼痛缓解和脑连通性的影响

本随机临床试验研究了背外侧前额叶皮质（DLPFC）间歇θ波爆发刺激（iTBS）对慢性腰痛（CLBP）患者疼痛缓解的影响及其潜在机制。方法将40例CLBP患者随机分为主动或假性iTBS联合核心稳定性训练两组。在干预前后分别完成疼痛评估。每组11名患者在干预前和干预后接受静息状态功能磁共振成像扫描，分析DLPFC的激活情况以及与其他大脑区域的连通性。结果主动iTBS组疼痛减轻程度明显高于假手术组（p = 0.05, 95% CI:−0.009 ~ 1.109）。在主动组和假手术组中，分别有80%（16/20）和40%（8/20）达到最小临床重要差异，需要治疗的数量为2.5。在恐惧回避信念问卷上，两组之间存在显著差异（p = 0.011, r = 0.40）。活跃iTBS组显示左侧DLPFC与右侧小脑以及两个枕回之间的功能连通性显著增强(体素水平，p < 0.001；簇级家庭误差率，p < 0.01)。Spearman相关分析显示，数值评定量表与左侧DLPFC和右侧小脑（rho = - 0.55, p = 0.008）、右侧（rho = - 0.439, p = 0.01）、左侧枕回（rho = - 0.45, p = 0.034）的FC呈显著负相关。结论iTBS可能通过增强DLPFC与小脑和枕回的连通性来减轻CLBP患者的疼痛。本研究显示iTBS对CLBP的缓解具有促进作用，可能与脑功能连通性有关。中国临床试验注册中心：ChiCTR2200064899

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来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.