Structural White and Gray Matter Correlates of Impaired Muscle Control and Deficient Pain Processing

NCT06143319 | Completed

• 1 other identifier: B670201422908 - EC/2014/1245
• Study Type: observational
• Target: 80
• Locations: 1 country
• Sites: 1

Brief Summary

Although the cause of persistent non-specific low back pain (LBP) remains unknown, structural and functional alterations of the brain, alterations in the lumbar muscles and dysfunction of the central nervous system have been proposed as underlying mechanisms. In this case-control study, 1) brain structure/function, 2) lumbar muscle function and 3) central pain processing are compared across four groups: 1) healthy participants, 2) recurrent LBP (both during pain flare and during pain remission), 3) chronic LBP and 4) fibromyalgia. According to previous research, healthy participants and fibromyalgia patients are two extremes of a "musculoskeletal pain continuum". Healthy participants representing one extreme of the continuum with no pain and fibromyalgia representing the other extreme of the continuum with chronic widespread pain. It is thought that different LBP populations (i.e. (sub)acute, recurrent, chronic LBP) float between the aforementioned extremes. Past studies already highlighted the need for studies comparing the pathophysiological mechanisms for different pain syndromes to identify common underlying mechanisms across pain syndromes. For this reason, the goal of the current study is to compare alterations in brain structure/function, alterations in lumbar muscle function and alterations in central pain processing across the aforementioned "musculoskeletal pain continuum". It is hypothesized that longer duration of pain (recurrent vs chronic) and the extensiveness of the pain (one location vs widespread pain) are associated with more pronounced alterations in 1) brain structure/function, 2) lumbar muscle function and 3) central pain processing.

Conditions

Low Back Pain; Low Back Pain, Recurrent; Low Back Pain, Chronic; Healthy Volunteers; Fibromyalgia

Keywords

low back pain; motor control; central sensitization; brain structure; brain function; central pain processing; fibromyalgia

Outcome Measures

Primary Outcomes (5)

• Brain structure and function

  The scanning session will comprise of (1) whole-brain T1-weighted structural MRI, (2) whole-brain DTI and (3) whole-brain resting-state functional MRI (rs-fMRI).

  The entirety of the protocol for each patient is administered in a single day, spanning approximately 4 to 5 hours.

• Pressure pain thresholds

  Pressure algometry for determining the PPT with a digital algometer bilaterally at three body locations, namely on the forearm (on the muscle belly of the extensor carpi radialis muscle), the erector spinae (5cm lateral to the processus spinosus of vertebra L3), and the calf (at the upper third of the distance between the knee crease and the distal border of the calcaneus)

  The entirety of the protocol for each patient is administered in a single day, spanning approximately 4 to 5 hours.

• Conditioned pain modulation

  A CPM paradigm during which the PPT (= test stimulus) is repeated during and after immersion of the non-dominant hand in a warm water bath (= conditioned stimulus) of 45.5°C for six minutes.

  The entirety of the protocol for each patient is administered in a single day, spanning approximately 4 to 5 hours.

• Nociceptive flexion reflex thresholds

  Repetitive TENS of the sural nerve of the dominant leg to determine the NFR threshold and temporal summation of the NFR threshold. A bar stimulating electrode will be connected to a constant current stimulator. Elicitation of the NFR will be evaluated by measuring the involuntary contraction of the ipsilateral biceps femoris.

  The entirety of the protocol for each patient is administered in a single day, spanning approximately 4 to 5 hours.

• Lumbar muscle function

  Lumbar muscle function will be measured by using surface EMG for testing APAs in a RAM test and CPAs in a QFRT.

  The entirety of the protocol for each patient is administered in a single day, spanning approximately 4 to 5 hours.

Secondary Outcomes (10)

• Pain intensity

  The entirety of the protocol for each patient is administered in a single day, spanning approximately 4 to 5 hours.

• Functional disability

  The entirety of the protocol for each patient is administered in a single day, spanning approximately 4 to 5 hours.

• Coping

  The entirety of the protocol for each patient is administered in a single day, spanning approximately 4 to 5 hours.

• Kinesiophobia

  The entirety of the protocol for each patient is administered in a single day, spanning approximately 4 to 5 hours.

• Catastrophizing

  The entirety of the protocol for each patient is administered in a single day, spanning approximately 4 to 5 hours.

Study Arms (4)

Recurrent low back pain

20 non-specific recurrent LBP patients, both experiencing a period of pain remission or a pain flare at the moment of testing, will be included in the current study.

Chronic low back pain

20 participants experiencing non-specific chronic LBP will be included in the current study.

Healthy volunteers

20 healthy participants, matched for age and Body Mass Index (BMI) with the participants experiencing chronic/recurrent low back pain or fibromyalgia will be included in the current study.

Fibromyalgia

20 participants diagnosed with fibromyalgia will be included in the current study

Eligibility Criteria

• Age: 18 Years - 45 Years
• Sex: female
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)
• Sampling Method: Non-Probability Sample

Study Population

All participants are women, recruited through advertisement in hospitals, patient groups and organizations, flyers, social media etc.

You may qualify if:

• Dutch speaking female participants (age between 18 and 45 years).
• Non-specific recurrent LBP patients experiencing a period of remission at the moment of testing. Patients have to meet the criteria for recurrent LBP (in remission) as described by De Vet et al. (2002) and D'Hooge et al. (2013).
• Non-specific recurrent LBP patients experiencing a pain flare at the moment of testing. Patients have to meet the criteria for recurrent LBP (during pain flare) as described by De Vet et al. (2002) and D'Hooge et al. (2013).
• Participants experiencing non-specific chronic LBP (meeting the International Association for the Study of Pain \[IASP\] criteria)
• Participants diagnosed with fibromyalgia according to the American College of Rheumatology (ACR) criteria (2010)
• Healthy volunteers with no history of serious respiratory, orthopedic, neurologic or circulatory conditions. No history of low back pain (i.e. low back pain in this case is defined as a period of symptoms lasting a minimum of 2 consecutive days and for which a paramedic is consulted). Participants with a history of spinal surgery, spinal trauma or spinal deformities are also excluded. Healthy participants will be matched for age and BMI with included participants experiencing chronic/recurrent LBP or fibromyalgia.

You may not qualify if:

• Pregnancy or breastfeeding in the past year
• Contraindications for MRI (e.g. electrical/mechanical implants or electrodes in de body, eye/skin injury by metal fragments in the past, etc)
• BMI lower than 18 or higher than 30
• Participant performed specific trunk muscle training in the past year.
• Participating in sports at a professional level

Sponsors & Collaborators

• University Ghent: lead
• Fund for Scientific Research, Flanders, Belgium: collaborator

Study Sites (1)

Ghent University, vakgroep revalidatiewetenschappen

Ghent, Oost-Vlaanderen, 9000, Belgium

Location

Related Publications (32)

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Related Links

• Goubert, D. (2017). Peripheral back muscle dysfunctions and central pain mechanisms : an innovative perspective on differences between recurrent and chronic pain. Ghent University. Faculty of Medicine and Health Sciences, Ghent, Belgium.
• Van der Zee, K. and R. Sanderman (1993). "RAND-36." Groningen: Northern Centre for Health Care Research, University of Groningen, the Netherlands 28(6).
• Kraaimaat, F., A. Bakker and A. Evers (1997). "Pijncoping-strategieën bij chronische pijnpatiënten: De ontwikkeling van de Pijn-Coping-Inventarisatielijst (PCI)."
• Crombez, G. (1996). "De Pain Catastrophizing scale (PCS)."

MeSH Terms

Conditions

Low Back Pain; Bronchiolitis Obliterans Syndrome; Fibromyalgia

Condition Hierarchy (Ancestors)

Back Pain; Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Organizing Pneumonia; Bronchiolitis Obliterans; Bronchiolitis; Bronchitis; Bronchial Diseases; Respiratory Tract Diseases; Lung Diseases, Obstructive; Lung Diseases; Graft vs Host Disease; Immune System Diseases; Muscular Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Neuromuscular Diseases; Nervous System Diseases

Study Officials

• Jessica Oosterwijck, Prof

  Ghent University, Pain in Motion

  PRINCIPAL INVESTIGATOR

• Lieven Danneels, Prof

  University Ghent

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: CASE CONTROL
• Time Perspective: CROSS SECTIONAL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: November 18, 2022
• First Posted: November 22, 2023
• Study Start: October 1, 2015
• Primary Completion: October 30, 2021
• Study Completion: October 30, 2021
• Last Updated: November 22, 2023

Record last verified: 2023-11

Data Sharing

• IPD Sharing: Will not share

Locations

BE (1)