Tuina Alleviates Pain Associated with Lumbar Disc Herniation by Regulating Functional Connectivity Between Inferior...

This study conducted a randomized controlled trial by analyzing resting-state functional magnetic resonance imaging (rs-fMRI) data to determine the mechanisms by which Tuina alleviates pain and modulates multiple brain networks in lumbar disc herniation (LDH) patients.

This study included 38 healthy subjects and 76 LDH patients. LDH patients were randomly assigned into the test group (TG; n = 38) and control group (CG; n = 38). TG patients received 14 days of Tuina therapy, whereas CG patients received a combination of transcutaneous electrical nerve stimulation (TENS) and lumbar traction therapy. The primary outcome measure, simplified McGill Pain Questionnaire (SF-MPQ), was used to assess pain. Pain pressure threshold (PPT), Oswestry Disability Index (ODI), Beck Depression Inventory II (BDI-II), and Beck Anxiety Inventory (BAI) were evaluated as secondary outcomes. Fractional amplitude of low-frequency fluctuation (fALFF) and functional connectivity (FC) values were evaluated from the rs-fMRI data before and after treatment.

The SF-MPQ score significantly decreased in both TG subjects [-13.00 (-19.00, -9.00); P <0.001] and CG subjects [-11.00 (-14.00, -7.00); P <0.001]. SF-MPQ scores were significantly different between the two groups (P <0.05). In TG subjects, Tuina inhibited spontaneous neural activity in the bilateral inferior frontal gyrus triangular part (IFGtri) and suppressed the interaction between IFGtri and other brain regions. Changes in FC between IFGtri.R and STG.pole.R positively correlated with improvements in SF-MPQ scores (r = 0.511, P = 0.005). Changes in FC between IFGtri.L and IFGtri.R negatively correlated with reduced PPT of the bilateral gluteus maximus (r = -0.518, P = 0.004).

Tuina effectively alleviates pain, lumbar dysfunction, and negative emotions in LDH patients by regulating the interactions between multiple neural networks in the brain, especially through the inferior frontal gyrus triangle area.