Changes in Motor Cortex Following Exercises for Chronic Low Back Pain - Full Text View

Sponsor:	The University of Queensland
Information provided by:	The University of Queensland
ClinicalTrials.gov Identifier:	NCT00864422

Purpose

The motor cortex of the brain changes following chronic pain and injury, and this is linked to pain-associated changes in motor behaviour. This study aimed to investigate whether therapeutic exercises in patients with chronic pain can induce reorganisation of the motor cortex and restore normal motor behaviour. The investigators hypothesised that motor training can induce reorganisation of the motor cortex and that these changes are related to improved motor behaviour.

Condition	Intervention	Phase
Chronic Low Back Pain	Behavioral: Skilled motor training Behavioral: Walking exercise	Phase I

Study Type:	Interventional
Study Design:	Basic Science, Randomized, Single Blind (Investigator), Active Control, Parallel Assignment, Efficacy Study
Official Title:	Driving Plasticity in the Motor Brain in Chronic Back Pain

Resource links provided by NLM:

MedlinePlus related topics: Back Pain Exercise and Physical Fitness

U.S. FDA Resources

Further study details as provided by The University of Queensland:

Primary Outcome Measures:

Motor cortical map and excitability from transcranial magnetic stimulation [ Time Frame: Pre and 2 weeks post-intervention ] [ Designated as safety issue: No ]

Secondary Outcome Measures:

Motor activation of the abdominal muscles during functional arm movement task [ Time Frame: Pre and 2 weeks post-intervention ] [ Designated as safety issue: No ]
Self-reported pain (VAS scale) and functional scale (patient-specific functional scale) [ Time Frame: Pre and 2 weeks post-intervention ] [ Designated as safety issue: No ]

Enrollment:	20
Study Start Date:	October 2006
Study Completion Date:	September 2007
Primary Completion Date:	September 2007 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
1: Experimental	Behavioral: Skilled motor training This involves training subjects to independently and cognitively activate the deep abdominal muscles, transversus abdominis, with minimal or no activity in other trunk muscles. The contraction is held for 10 seconds and subjects complete three blocks of ten contractions, twice per day for two weeks. This training protocol is commonly used clinically for people with chronic back pain.
2: Active Comparator	Behavioral: Walking exercise The control intervention involves walking exercises for ten minutes, twice per day. Subjects are advised to walk at their own pace with no instructions on activation of specific trunk muscles. The exercise is performed over two weeks.

Arms

Assigned Interventions

1: Experimental

Behavioral: Skilled motor training

This involves training subjects to independently and cognitively activate the deep abdominal muscles, transversus abdominis, with minimal or no activity in other trunk muscles. The contraction is held for 10 seconds and subjects complete three blocks of ten contractions, twice per day for two weeks. This training protocol is commonly used clinically for people with chronic back pain.

2: Active Comparator

Behavioral: Walking exercise

The control intervention involves walking exercises for ten minutes, twice per day. Subjects are advised to walk at their own pace with no instructions on activation of specific trunk muscles. The exercise is performed over two weeks.

Detailed Description:

The sensory and motor systems can reorganize following injury and learning of new motor skills. Recently we observed adaptive changes in motor cortical organization in patients with chronic back pain, which are closely linked to changes in motor behavior. Although pain-related alterations in behavior can be trained and are associated with improved symptoms, it remains unclear whether these meaningful functional outcomes are related to motor cortical reorganization. Here we investigate the effects of two interventions in people with chronic back pain: skilled motor training and a control intervention of self-paced walking exercise. We measured motor cortical excitability (motor threshold (MT)) and organization (center of gravity (CoG) and map volume) of the deep abdominal muscle, transversus abdominis (TrA), using transcranial magnetic stimulation (TMS). In addition, motor behavior of TrA was assessed during single rapid arm movements. The study helps to elucidate the mechanisms of specific motor exercises in chronic back pain management.

Eligibility

Ages Eligible for Study:	18 Years to 55 Years
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Sustained or episodic non-specific low back pain lasting longer than 3 months

Exclusion Criteria:

Orthopaedic, neurological, circulatory or respiratory conditions
History or family history of epilepsy
Recent or current pregnancies
Previous surgery to the abdomen or back
Abdominal or back exercises in the preceding 12 months

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00864422

Locations

Australia, Queensland
Centre for Clinical Research Excellence in Spinal Pain, Injury and Health
Brisbane, Queensland, Australia, 4072

Sponsors and Collaborators

The University of Queensland

Investigators

Study Director:	Paul W Hodges, MedDr (Neurosci) PhD BPhty	The University of Queensland
Principal Investigator:	Henry Tsao, PhD MPhty (Manipulative) BPhty	The University of Queensland

More Information

No publications provided

Responsible Party:	Centre for Clinical Research Excellence in Spinal Pain, Injury and Health ( Dr Henry Tsao )
Study ID Numbers:	NHMRC-ID351656, NHMRC-ID401599, PRF-007/06
Study First Received:	March 17, 2009
Last Updated:	March 17, 2009
ClinicalTrials.gov Identifier:	NCT00864422 History of Changes
Health Authority:	Australia: National Health and Medical Research Council

Keywords provided by The University of Queensland:

low back pain
motor training
motor cortex
brain plasticity

Additional relevant MeSH terms:

Signs and Symptoms
Nervous System Diseases
Neurologic Manifestations

Low Back Pain
Pain
Back Pain

ClinicalTrials.gov processed this record on February 08, 2010