1 www.fomt.info [email protected]1 !Osteopathie! ,Osteopathie, Rückenschmerz – Funk7onelle Zusammenhänge aus osteopathischer Sicht Herzlich willkommen! Stefan Grundler Heimerer Akademie FOMT Fortbildungen für Orthopädische Medizin und Manuelle Therapie ,Osteopathie, „Nacken, und Rücken, schmerzen sind ein natürlicher Teil des Lebens.“ Einführung „
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who had obvious structural alterations and cured with
ordinary orthopedic treatment, and (2) CLBP group clas-sified as pain disorder with the psychiatric classification or
NSLBP [7], whose pain had continued more than 6 months
despite ordinary medical treatment and with indigentstructural abnormalities. We first investigated the brain
blood flow in each group. As expected, the blood flow was
decreased in the prefrontal cortex of the frontal lobe, andwas increased in the posterior lobe of the cerebellum in the
CLBP group. Also, the increased blood flow in thesomatosensory cortex of the parietal lobe was observed,
although there was no statistical difference among the data
in the CLBP group.By comparing the brain MRI in patients with CLBP and
in normal subjects, Apkarian et al. [5] previously have
reported on the mechanism of pain perception and foundthat the frontal cortex was significantly atrophied in the
CLBP group. Recently, the progression of functional neu-
roimaging systems have made it possible to visualize intra-cerebral changes in patients with CLBP. It is common that
functional brain images, such as fMRI or PET, examine the
brain reaction at the time of nociceptive stimuli to thepatients. However, Baliki et al. [11] have reported that the
pain perception and related cortical activation patterns
were similar between CBP patients and controls inresponse to acute noxious thermal stimuli.
Therefore, we performed brain SPECT focusing on the
cortical activities without noxious stimuli. Brain SPECT isan easy-to-use technique and suffers minimum stressors to
the patients that involve only the administration of a
radioisotope through the venous circulation and visualizesthe accumulation of radioisotope by tomographic imaging
[8]. Using brain SPECT (one-tailed view), we have already
reported that the decreased blood flow of prefrontal cortexregions in 15 patients with chronic pain was observed [12].
Loeser proposes ‘‘the multifaceted model of pain’’ that
involves 4 domains of pain phenomena: (1) the detection oftissue damage (nociception), (2) the recognition of noci-
ceptive stimulation by the central nervous system (pain),
(3) the negative affective response to pain (suffering), and(4) what a person does or does not do or say that leads the
observer to infer that the patient is suffering from a noxiousstimulus (pain behavior) [13].
CLBP2 CLBP1
CLBP5
CLBP3
CLBP7 CLBP6 CLBP4
ALBP2 ALBP1 ALBP4
ALBP5 ALBP7 ALBP6
ALBP3
Fig. 3 Each patient data of inferior views of brain blood flow in theCLBP group and the ALBP group. A representative case CLBP5 isshown on the most upper left. Other CLBP1, 2, 3, 4, 6, and 7 cases arealso shown on the upper right sides. A representative case ALBP3 isshown on the most lower left. Other ALBP1, 2, 4, 5, 6, and 7 cases arealso shown on the lower right sides. Note that the CLBP groupshowed significantly increased blood flow in the bilateral posteriorlobe of the cerebellum
CLBP2CLBP1
CLBP5
CLBP3
CLBP7CLBP6CLBP4
ALBP2ALBP1 ALBP4
ALBP5 ALBP7ALBP6
ALBP3
Fig. 4 Each patient data of anterior views of brain blood flow in theCLBP group and the ALBP group. A representative case CLBP5 isshown on the most upper left. Other CLBP1, 2, 3, 4, 6, and 7 cases arealso shown on the upper right sides. A representative case ALBP3 isshown on the lowest left. Other ALBP1, 2, 4, 5, 6, and 7 cases are alsoshown on the lower right sides. Note that the CLBP group showedsignificantly reduced blood flow in the bilateral prefrontal cortex ofthe frontal lobe