Effects of Physical Exercise Training on Chronic Low Back Pain are Mediated by Changes in Frontostriatal Connectivity and Gene Expression

Chronic low back pain is a prevalent and debilitating condition that can be difficult to resolve. One effective approach is physical exercise training. This study investigates the hypothesis that exercise training normalizes immune-brain interactions that cause pain exacerbation and perpetuation. Fifty-seven participants with chronic low back pain were randomized into a 14-week exercise training program or a wait-list control condition. Exercise training led to significant reductions in pain and disability. Brain imaging analyses revealed decreased nucleus accumbens and medial prefrontal cortex (NAc-mPFC) connectivity, suggesting a normalization of reward circuitry. Gene expression analysis in immune cells indicated that exercise training produced changes in biological pathways related to immune function, stress, and inflammation. In alignment with the hypothesis, the observed changes in NAc-mPFC connectivity and gene expression were found to mediate the effects of exercise training on chronic low back pain.