| Objective:A parallel randomized controlled trial was conducted to observe the effect of Yi Jin Jing on chronic pain symptoms in patients with knee osteoarthritis,and to explore the mechanism of Yi Jin Jing modulated default mode network to relieve chronic pain of knee osteoarthritis combined with functional magnetic resonance imaging(f MRI).Methods:In this study,38 subjects with knee osteoarthritis were recruited and randomly assigned to the Yi Jin Jing group and the stationary squat group.Patients in both groups received the same basic treatment.The Yi Jin Jing group needed to practice for 40 minutes each time,3 times a week,for 12 consecutive weeks.The stationary squat group needed to practice for 40 min each time,3 times a week,for 12 consecutive weeks.Before and after intervention,Osteoarthritis Index Scale,visual analogue scale of Pain and hamilton Anxiety Scale were used to evaluate the symptoms of the two groups of subjects.SPSS 20.0 was used for statistical analysis.T test and non-parametric rank sum test were used to compare the differences within and between groups.Functional magnetic resonance imaging(f MRI)was used to collect the resting state,task state and structural image data of the brains of the patients with knee osteoarthritis.DPABI and SPM12 were used to compare the brain of functional differences between the two groups,and the peak value of the default mode network difference brain region and pain score were extracted for correlation analysis.Results:1.There were no statistically significant differences in subjects’ gender,age,BMI,education level,knee joint K-L grade and disease course between the Yi Jin Jing group and the stationary squat group(P>0.05).Before intervention,there were no significant differences in total Osteoarthritis Index score,pain score,stiffness score,function score,visual analogue scale score of pain and Hamilton anxiety score between the two groups(P>0.05).2.After 12 weeks of intervention,Yi Jin Jing group of total osteoarthritis index score,pain score,stiffness score,function score,visual analogue scale score of pain,Hamilton anxiety scale significantly decreased,compared with before(P<0.05);The total score of osteoarthritis Index,pain score,function score and visual analogue scale score of pain in stationary squat group were significantly lower than those before intervention(P<0.05),Osteoarthritis index stiffness score and Hamilton anxiety score were not significantly changed(P>0.05);Compared with the stationary squat group,the Osteoarthritis Index pain score,function score,visual analogue scale score of pain and Hamilton anxiety score changed significantly in the Yi Jin Jing group(P<0.05).3.f ALFF analysis found that 12 weeks of intervention later,the Yi Jin Jing group of KOA patients with lingual gyrus,right fusiform gyrus,right middle temporal gyrus,right middle occipital gyrus,cuneus,left calcarine fissure and surrounding cortex,right superior temporal gyrus,right precuneus,left median cingulate and paracingulate gyri,left supplementary motor area,right precentral gyrus f ALFF is higher than before the intervention(P<0.05).f ALFF of right superior frontal gyrus(dorsolateral),right superior parietal gyrus in the stationary squat group were lower than those before intervention(P<0.05).Compared with the stationary squat group,f ALFF in the left cuneus,the left cuneus,right calcarine fissure and surrounding cortex,right precuneus in the Yi Jin Jing group were significantly changed(P<0.05).Re Ho analysis found that 12 weeks of intervention later,the Yi Jin Jing group of KOA patients right temporal pole: middle temporal gyrus,right Inferior temporal gyrus,right middle temporal gyrus,right middle occipital gyrus,right rolandic operculum,right Insula,right calcarine fissure and surrounding cortex,right superior temporal gyrus,right supramarginal gyrus,right median cingulate and paracingulate gyri,left median cingulate and paracingulate gyri,left supplementary motor area,right postcentral gyrus,right precentral gyrus Re Ho increase,compared with before(P<0.05).In the stationary squat group,there was an increase in Re Ho in the right fusiform gyrus in patients with KOA(P<0.05).The difference of Re Ho between the two groups before and after intervention showed that the changes of Re Ho in the right median cingulate and paracingulate gyri,right angular gyrus,right superior parietal gyrus in the Yi Jin Jing group were more significant than those in the stationary squat group(P<0.05).Task state brain activation analysis found that 12 weeks of intervention later,Yi Jin Jing group of KOA patients with knee flexion motion supplementary motor area,left paracentral lobule,left lingual gyrus,left fusiform gyrus,left superior cerebellar,precuneus,calcarine fissure and surrounding cortex,left cuneus activation degree increased significantly,compared with before(P<0.05);In the stationary squat group,the activation degree of the right calcarine fissure and surrounding cortex,right cuneus in the knee flexion and extension activity of KOA patients decreased compared with that before intervention(P<0.05).4.Correlation analysis showed that there was a positive correlation between f ALFF difference in the right precuneus and osteoarthritis index pain score difference(r=0.594,P=0.019),and the right temporal pole: middle temporal gyrus Re Ho difference and osteoarthritis index pain score difference showed a negative correlation(r=-0.742,P=0.002),the left cuneus task state activation difference was negatively correlated with the osteoarthritis index pain score difference(r=-0.643,P=0.01),the left precuneus task state activation difference was negatively correlated with the osteoarthritis index pain score difference(r=-0.578,P=0.024)before and after intervention in the Yi Jin Jing group;Two groups before and after the intervention of right precuneus f ALFF difference value and the difference of VAS value showed a negative correlation(r=-0.435,P=0.014),the two groups before and after the intervention of right angular gyrus Re Ho difference value and the difference value of VAS value showed a negative correlation(r=-0.368,P=0.041),the two groups before and after the intervention by the right median cingulate and paracingulate gyri Re Ho difference value and negatively correlated with VAS difference value(r=-0.467,P=0.008),and there was a negative correlation between the Re Ho difference value in the right median cingulate and paracingulate gyri and the WOMAC pain difference value before and after intervention in the two groups(r=-0.534,P=0.002).Conclusion:1.Yi Jin Jing and stationary squat training can relieve chronic pain symptoms in patients with KOA,Yi Jin Jing has more advantages in improving chronic KOA pain.2.Yi Jin Jing can improve the anxiety caused by chronic pain symptoms in patients with KOA,while stationary squat training has no effect on anxiety relief.3.Yi Jin Jing and stationary squat training can improve chronic pain in patients with KOA by enhancing the activation of pain and emotion related brain regions in the resting state,and Yi Jin Jing has a more significant effect on the brain function in the resting state.4.Yi Jin Jing and stationary squat training can enhance the activation degree of brain pain and emotion related brain regions during knee flexion and extension,and improve chronic pain in patients with KOA,moreover,the effect of Yi Jin Jing on the brain function during flexion and extension of knee joint was more significant.5.Activation changes in brain regions related to default network,mainly in cuneus and precuneus,are one of the main mechanisms of Yi Jin Jing alleviating chronic pain in patients with KOA. |
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