Association between sensorimotor impairments and functional brain changes in patients with low back pain: a critical review

Abstract Low back pain (LBP) coincides with sensorimotor impairments, e.g., reduced lumbosacral tactile and proprioceptive acuity and postural control deficits. Recent functional magnetic resonance imaging (fMRI) studies suggest that sensorimotor impairments in LBP may be associated with brain changes. However, no consensus exists regarding the relationship between functional brain changes and sensorimotor behavior in LBP. Therefore, this review critically discusses the available fMRI studies on brain activation related to non-nociceptive somatosensory stimulation and motor performance in individuals with LBP. Four electronic databases were searched, yielding nine relevant studies. Patients with LBP showed reduced sensorimotor-related brain activation and a reorganized lumbar spine representation in higher-order (multi)sensory processing and motor regions, including primary and secondary somatosensory cortices, supplementary motor area and superior temporal gyrus. These results may support behavioral findings of sensorimotor impairments in LBP. Additionally, patients with LBP displayed widespread increased sensorimotor-evoked brain activation in regions often associated with abnormal pain processing. Over-activation in these regions could indicate an over-responsiveness to sensory inputs that signal potential harm to the spine, thereby inducing over-generalized protective responses. Hence, functional brain changes could contribute to the development and recurrence of LBP. However, future studies investigating the causality between sensorimotor-related brain function and LBP are imperative. Correspondence: Nina Goossens, Mailing address: KU Leuven – University of Leuven, Department of Rehabilitation Sciences – Musculoskeletal Rehabilitation Research Group, Tervuursevest 101, box 1501, B-3001 Leuven, Belgium, Phone number: +32 16 37 90 40, Fax number: +32 16 32 91 97, Email address: Nina.Goossens@kuleuven.be Author Disclosures: Competing Interests: All authors (NG, SR, LJ, KC, SB) declare no conflicts of interest. Funding or grants or equipment provided for the project from any source: This study was funded by the Agency for Innovation by Science and Technology (Agentschap voor Innovatie door Wetenschap en Technologie IWT) (PhD Grant for Strategic Basic Research Nina Goossens, grant number ZKC9172-00-W01) and by the Research Foundation Flanders (Fonds Wetenschappelijk Onderzoek FWO) (Postdoctoral Fellowship Lotte Janssens, grant number 12M9815N). Financial benefits to the authors: All authors declare to have no financial benefit from this manuscript. Details on any previous presentation of the research, manuscript, or abstract in any form: This manuscript or abstract has not been presented anywhere in any form. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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