Osteopathy modulates brain-heart interaction in chronic pain patients: an ASL study

Abstract

In this study we used a combination of measures including regional cerebral blood flow (rCBF) and heart rate variability (HRV) to investigate brain-heart correlates of longitudinal baseline changes of chronic low back pain (cLBP) after osteopathic manipulative treatment (OMT). Thirty-two right-handed patients were randomised and divided into 4 weekly session of OMT (N = 16) or Sham (N = 16). Participants aged 42.3 ± 7.3 (M/F: 20/12) with cLBP (duration: 14.6 ± 8.0 m). At the end of the study, patients receiving OMT showed decreased baseline rCBF within several regions belonging to the pain matrix (left posterior insula, left anterior cingulate cortex, left thalamus), sensory regions (left superior parietal lobe), middle frontal lobe and left cuneus. Conversely, rCBF was increased in right anterior insula, bilateral striatum, left posterior cingulate cortex, right prefrontal cortex, left cerebellum and right ventroposterior lateral thalamus in the OMT group as compared with Sham. OMT showed a statistically significant negative correlation between baseline High Frequency HRV changes and rCBF changes at T2 in the left posterior insula and bilateral lentiform nucleus. The same brain regions showed a positive correlation between rCBF changes and Low Frequency HRV baseline changes at T2. These findings suggest that OMT can play a significant role in regulating brain-heart interaction mechanisms.

Figure 1

The effects of osteopathic treatment on regional cerebral flow. The figure shows CBF changes baseline-controlled group differences between treatment and sham group at T2 (referring to the contrast described in the text as (T2_OMT–T0_OMT) vs (T2_SHAM–T0_SHAM)—p < 0.01, false discovery rate (FDR) corrected). L-MFG left middle frontal gyrus, L-pINS left posterior insula, L-LN left lentiform nucleus, L-Cereb(CrI) left cerebellum (Crus I), L-ACC left anterior cingulate cortex, L-SPL left superior parietal lobe, L-PCC left posterior cingulate cortex, L-THAL left thalamus, L-CU left cuneus, R-ACC right anterior cingulate cortex, R-MOFG right mid orbitofrontal gyrus, R-OFC right orbito frontal cortex, R-vplTHAL right ventroposterior lateral thalamus, R-daINS right dorsal anterior insula, R-vaINS right ventral anterior insula.

Figure 2

Longitudinal CBF delta changes. The figure shows the longitudinal CBF mean change within the regions of interest for the two groups. *Statistically significant differences (p < 0.05) between groups.

Figure 3

Correlation between rCBF and pain. The figure shows the significant positive and negative correlations between regional cerebral blood flow mean changes within ROI and pain intensity changes in the treatment group.

Figure 4

Heart rate variability changes between the study and control group. Heart rate variability (HRV) findings for: (A) high frequency (HF) normalised units (nu); (B) detrended fluctuation scaling exponent (DFAα1); (C) low frequency/high frequency ratio (LF/HF); (D) low frequency (LF—nu). Data presented are means ± standard deviation (SD). *Statistically significant differences (p < 0.05) in OMT group compared to sham and control groups.

Figure 5

Correlation between heart rate variability changes and rCBF in the study group. The figure shows the significant positive and negative correlations between regional cerebral blood flow mean changes within ROI and nuHF (red line) and nuLF (cyan line) changes in the treatment group.