The Central Mechanism Of Cervical Exercise Guidance Training In The Treatment Of Chronic Pain In Cervical Spondylosis

Objective: The purpose of our study was to investigate the effect of cervical exercise guidance training in the treatment of chronic neck pain in cervical spondylosis and to reveal its central therapeutic mechanism by combined with brain Resting state functional Magnetic Resonance Image.Methods: 60 patients were enrolled and randomly divided into control group(n =30)and experimental group(n = 30),the patients in control group were treated with massage and the patients in experimental group were treated with massage(the same as control group)and cervical exercise guidance training.The patients were received massage the next day,about 30 minutes each time,a total of 10 times.Cervical exercise guidance training(a total of three movements)was performed after massage and each movements were repeated 10-15 times in experimental group,the whole process takes3-5 minutes.The Neck Disability Index(NDI),Self-rating Anxiety Scale(SAS),Range of Motion(ROM)of cervical vertebra,Visual Analogue Scoring(VAS)of neck and shoulder pain were evaluated and the brain Resting state functional Magnetic Resonance Image data were collected before and after treatment.Results :(1)After receiving treatment,the NDI and SAS of the two groups were4.67±2.37,39.00±7.77 and 3.83±1.84,36.73±7.70 respectively.The results showed that the NDI and SAS were significantly improved in all groups after treatment(P<0.05),but there was no significant difference between the two groups(P>0.05).(2)Our results showed that there was no statistical significance in the change of ROM of cervical vertebra after massage in patients in the control group(P>0.05),while the ROM of left and right flexion of cervical vertebra in patients in the experimental group was significantly improved after receiving massage and cervical exercise guidance training(P>0.05).However,there was no statistical significance between the two groups(P>0.05).(3)After receiving the treatment,the VAS of neck and shoulder pain(including six positions: left and right suboccipital,left and right neck,left and right shoulder)in both groups could be improved(P<0.05).But only the improvement of left and right suboccipital pain in the experimental group was more significant(P<0.05).(4)The Amplitude of Low Frequency Fluctuation(ALFF)was used to analyze the data of brain Resting state functional Magnetic Resonance Image(Re-f MRI).The results showed that after treatment the brain regions with increased ALFF in the control group were distributed in the left anterior central gyrus、posterior central gyrus、superior temporal gyrus、middle temporal gyrus、transverse temporal gyrus、insula、paracentral lobule、supplementary motor area、central sulcus cover、lactiform putamen、medial and paracingulate gyrus;Right superior temporal gyrus、middle temporal gyrus、inferior temporal gyrus、transverse temporal gyrus、insula、parhippocampal gyrus、inferior occipital gyrus、central sulcus lid、lingual gyrus(P<0.005).The brain regions with decreased ALFF in the control group were distributed in the left angular gyrus、parietal inferior marginal angular gyrus、middle occipital gyrus、parietal gyrus、precuneus、posterior cingulate gyrus、superior marginal gyrus;Right angular gyrus、inferior parietal angular gyrus、superior cerebellum、inferior cerebellum、anterior cingulate gyrus、paracingulate gyrus(P<0.005).The brain regions with increased ALFF in the experimental group were distributed in the left anterior central gyrus、posterior central gyrus、superior temporal gyrus、middle temporal gyrus、transverse temporal gyrus、insula、central sulcus cover、parafentral lobule、supplementary motor area;Right anterior central gyrus、posterior central gyrus、superior temporal gyrus、middle temporal gyrus、transverse temporal gyrus、middle occipital gyrus、 insula、central sulcus lid(P<0.005).The brain regions with decreased ALFF in the experimental group were distributed in the left precuneus、upper cerebellum、lower cerebellum、caudate nucleus;Right angular gyrus、inferior parietal angular gyrus、superior cerebellum、inferior cerebellum、precuneus、superior gyrus、medial gyrus and paracingulate gyrus;Bilateral medial and parapingulate gyrus、posterior cingulate gyrus、precuneus(P<0.005).The brain regions with increased ALFF between two groups were distributed in the left posterior central gyrus 、 anterior central gyrus 、paracentral lobule;Right superior temporal gyrus 、 middle temporal gyrus(P<0.005).And the brain regions with decreased ALFF between two groups were distributed in the left precuneus;Right upper cerebellum、lower cerebellum、 medial and paracingulate gyrus、precuneus、inferior parietal angular gyrus(P<0.005).Conclusion: Cervical exercise guidance training combined with massage can significantly reduce the score of NDI and SAS in patients with chronic neck pain in cervical spondylosis.As well as the ROM in the left and right flexion of the cervical vertebra and the VAS of the chronic pain in left and right suboccipital in patients with cervical spondylosis were improved after receiving cervical exercise guidance training on the basis of massage.Cervical exercise guidance training may affect the sensory response of patients to chronic neck pain in cervical spondylosis by changing the functional activities of brain regions related to pain and emotional processing,such as posterior central gyrus、anterior central gyrus、superior temporal gyrus、middle temporal gyrus、precuneus.