P.V. BYKOVSKII, M.A. SHERMAN

Kirov State Medical University, Kirov

Contact details:

Sherman M.A. — MD, Professor, Head of the Department of Neurology, Neurosurgery and Neurorehabilitation

Address: 112 Karl Marks St., Russian Federation, Kirov, 610998, tel.: +7-912-826-06-05, e-mail: sherman@list.ru

Impaired postural control and balance and abnormal compensatory postural strategies are one of the pathogenetic mechanisms of development and chronicity of acute nonspecific neck and lower back pain. Stabilometry is a common and objective diagnostic technique that evaluates the postural control.

The purpose is to determine the effectiveness of the alpha neurofeedback training for acute nonspecific neck and lower back pain, using the stabilometry.

Material and methods. The study included 60 patients with acute nonspecific vertebrogenic pain. The patients were divided into two equal groups (30 people in each group) by random sampling depending on the treatment protocol. The neurofeedback technique and basic therapy was applied for patients of the main group while 30 patients of the control group had only basic therapy applied to them. All measurements were performed before and after treatment. Postural control was assessed using computerized posturography (stabilometry). Postural variables examined were the centre of pressure (CoP) location, CoP average sway, total CoP area sway, and CoP sway velocity. The effectiveness of treatment was assessed by the dynamics of postural stability, the pain score (VAS), the anxiety score (SCL-90-R) and the alpha rhythm index.

Results. The intervention group displayed significant (p < 0,05) improvement in postural stability at the end of treatment. There were significant differences between the intervention and control groups in CoP average sway and total CoP area sway. Both groups exhibited a decrease in anxiety scale.

Conclusions. The alpha neurofeedback training yielded improvements in posturography and pain outcomes. Our study also confirms the applicability of stabilometry in evaluating postural instability in patients with nonspecific neck and lower back pain.

Key words: stabilometry, neurofeedback, alpha training, acute nonspecific pain, neck and lower back pain.

REFERENCES

1. Henschke N., Maker C.G., Refshauge K.M. et al. Characteristics of Patients With Acute Low Back Pain Presenting to Primary Care in Australia. Slin J Pain, 2009, vol. 25, pp. 5–11.
2. Kurenkov E.L., Makarova V.V. Some aspects of the pathogenesis of degenerative changes in the intervertebral disc in humans (literature review). Vyatskiy meditsinskiy vestnik, 2018, no. 2, pp. 52–57 (in Russ.).
3. Claeys K., Dankaerts W., Janssens L. et al. Young individuals with a more ankle-steered proprioceptive control strategy may develop mild non-specific low back pain. Journal of Electromyography and Kinesiology, 2015, vol. 25 (2), pp. 329–338.
4. Leitner C., Mair P., Paul B. et al. Reliability of posturographic measurements in the assessment of impaired sensorimotor function in chronic low back pain. J Electromyograph Kinesiol, 2009, vol. 19 (3), pp. 380–390.
5. Mancini M., Horak F.B. The relevance of clinical balance assessment tools to differentiate balance deficits. Eur J Phys Rehabil Med, 2010, vol. 46, pp. 239–248.
6. Donocik K., Hartman-Petrycka M., Lebiedowska A., Błońska-Fajfrowska B. Alterations in the ability to maintain balance as a result of stochastic resonance whole body vibration in women. PLoS ONE, 2017, vol. 12 (9), p. e0185179.
7. Shahbazi Moheb Seraj M., Sarrafzadeh J., Maroufi N. et al. Comparison of Postural Balance between Subgroups of Nonspecific Low-back Pain Patients Based on O’Sullivan Classification System and Normal Subjects during Lifting. Arch Bone Jt Surg, 2019, vol. 7 (1), pp. 52–60.
8. Ramond A., Bouton C., Richard I. et al. Psychosocial risk factors for chronic low back pain in primary care a systematic review. Fam Pract, 2011, vol. 28 (1), pp. 12–21.
9. Hallegraeff J.M., Kan R., van Trijffel E., Reneman M.F. State anxiety improves prediction of pain and pain-related disability after 12 weeks in patients with acute low back pain: a cohort study. J Physiother, 2020, vol. 66 (1), pp. 39–44.
10. Vernon D.J. Can Neurofeedback Training Enhance Performance? An Evaluation of the Evidence with Implications for Future Research. Applied Psychophysiol Biofeedback, 2005, vol. 30 (4), pp. 347–364.
11. Bean D.J., Johnson M.H., Kydd R.R. Relationships Between Psychological Factors, Pain, and Disability in Complex Regional Pain Syndrome and Low Back Pain. Clin J Pain, 2014, vol. 30 (8), pp. 647–653.
12. Jensen M.P., Day M.A., Miro J. Neuromodulatory treatments for chronic pain: efficacy and mechanisms. Nat Rev Neurol, 2014, vol. 10 (3), pp. 167–178.
13. Mayaud L., Wu H., Barthélemy Q. et al. Alpha-phase synchrony EEG training for multi-resistant chronic low back pain patients: an open-label pilot study. Eur Spine J, 2019, vol. 28 (11), pp. 2487–2501.
14. Gomes J.S., Ducos D.V., Akiba H., Dias Á.M. A neurofeedback protocol to improve mild anxiety and sleep quality. Braz J Psychiatry, 2016, vol. 38 (3), pp. 264–265.
15. Ruhe A., Fejer R., Walker B. Altered postural sway in patients suffering from non-specific neck pain and whiplash associated disorder-A systematic review of the literature. Chiropract Manual Therap, 2011, vol. 19 (1), p. 13.
16. Sohn M.K., Lee S.S., Song H.T. Effects of acute low back pain on postural control. Ann Rehabil Med, 2013, vol. 37 (1), pp. 17–25.
17. Taradaj J., Rajfur K., Rajfur J. et al. Effect of laser treatment on postural control parameters in patients with chronic nonspecific low back pain: a randomized placebo-controlled trial. Braz J Med Biol Res, 2019, vol. 52 (12), p. e8474.
18. Azadinia F., Ebrahimi-Takamjani I., Kamyab M. et al. A RCT comparing lumbosacral orthosis to routine physical therapy on postural stability in patients with chronic low back pain. Med J Islam Repub Iran, 2017, vol. 31, p. 26.
19. Patti A., Bianco A., Paoli A. et al. Pain Perception and Stabilometric Parameters in People With Chronic Low Back Pain After a Pilates Exercise Program: A Randomized Controlled Trial. Medicine (Baltimore), 2016, vol. 95 (2), p. e2414.
20. Sereda Y., Dembitskyi S. Validity assessment of the symptom checklist SCL-90-R and shortened versions for the general population in Ukraine. BMC Psychiatry, 2016, vol. 16 (1), p. 300.
21. Kompleks reabilitatsionnyy psikhofiziologicheskiy dlya treninga s biologicheskoy obratnoy svyaz’yu «REAKOR»: metodicheskie ukazaniya [Complex rehabilitation psychophysiological for training with biological feedback «REACOR»: guidelines]. Taganrog: NPKF «Medikom MTD», 2007. 162 p.
22. Sorokina N.D., Selitskiy G.V., Terementseva E.S. The effectiveness of various types of biofeedback therapy for tension headache. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova, 2014, no. 2 (114), pp. 29–33 (in Russ.).
23. Gazhe P.-M., Veber B. Posturologiya. Regulyatsiya i narusheniya ravnovesiya tela cheloveka: per. s fr. Izd. 3-e, ster. [Posturology. Regulation and imbalance of the human body: trans. with fr. Ed. 3rd, stereotyped]. Saint Petersburg: SPbMAPO, 2008. 312 p.
24. Van Dieën J.H., Koppes L.L., Twisk J.W. Low back pain history and postural sway in unstable sitting. Spine, 2010, vol. 35 (7), pp. 812–817.
25. Hodges P.W., Moseley G.L. Pain and motor control of the lumbopelvic region: effect and possible mechanisms. J Electromyogr Kinesiol, 2003, vol. 13 (4), pp. 361–370.
26. Van Daele U., Hagman F., Truijen S. et al. Decrease in postural sway and trunk stiffness during cognitive dual-task in nonspecific chronic low back pain patients, performance compared to healthy control subjects. Spine, 2010, vol. 35 (5), pp. 583–589.
27. Craig C.E., Goble D.J., Doumas M. Proprioceptive acuity predicts muscle co-contraction of the tibialis anterior and gastrocnemius medialis in older adults’ dynamic postural control. Neuroscience, 2016, vol. 322 (1), pp. 251–261.
28. Wand B.M., Di Pietro F., George P., O’Connell N.E. Tactile thresholds are preserved yet complex sensory function is impaired over the lumbar spine of chronic non-specific low back pain patients: a preliminary investigation. Physiotherapy, 2010, vol. 96 (4), pp. 317–323.
29. Shumway-Cook A., Woollacott M.H. Motor control: translating research into clinical practice. Baltimore: Lippincott Williams & Wilkins, 2007. Pp. 12–89.
30. Clendaniel R.A., Landel R. Management of cervicogenic dizziness. 4rd ed. Philadelphia: F.A. Davis Company, 2014. Pp. 590–609.
31. Treleaven J. Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. Man Ther, 2008, vol. 13 (1), pp. 2–11.
32. Jull G., Falla D., Treleaven J., O’leary S. Neck pain disorders. Management of neck pain disorders. Amsterdam: Elsvier, 2019. Pp. 12–89.
33. Neuper C., Pfurtscheller G. Event-related dynamics of cortical rhythms: frequency-specific features and functional correlates. Int J Psychophysiol, 2001, vol. 43, pp. 41–58.
34. Ishigaki T., Ueta K., Imai R., Morioka S. EEG frequency analysis of cortical brain activities induced by effect of light touch. Exp Brain Res, 2016, vol. 234 (6), pp. 1429–1440.
35. Bykovskiy P.V., Sherman M.A. Possibilities of using the neurofeedback technique as part of the complex therapy of acute nonspecific pain in the neck and lower back. Rossiyskiy zhurnal boli, 2020, no. 2 (18), pp. 14–19 (in Russ.).