Therapeutic Effects of Horticulture on Anterior Cingulate Cortex Activation in People With Chronic Low Back Pain
Condition: Low Back Pain
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      Chronic low back leads to a significant socio-economic burden. It is associated with physical
      and psychosocial deconditioning. Even a short "nature experience" has positive effects on the
      affective and cognitive factors involved in chronic pain. In the brain, the anterior
      cingulate cortex plays an important role in both pain and emotions. Exposure to a natural
      environment may decrease activation of the anterior cingulate cortex.

      The main objective of this study is to evaluate the effectiveness of therapeutic horticulture
      on the decrease of activation of the anterior cingulate cortex in people with chronic low
      back pain participating in 2 sessions of 90 minutes of therapeutic horticulture and 2
      sessions of 90 minutes of handiwork.

      The investigators hypothesize that therapeutic horticulture may reduce the activation of the
      anterior cingulate cortex. The effects of therapeutic horticulture may be mediated through
      the double exposure to both nature and physical activity.
    

Detailed description: 
      Non-specific low back pain is the first cause of years lived with a disability in the world.
      The network of biological, psychological and social contributors to chronic low back pain is
      complex. Within this network, physical and mental deconditioning are a key point and a
      privileged therapeutic target of multidisciplinary training programs.

      Physical exercise improves pain and function in people with chronic low back pain.
      Nevertheless, its benefits decrease if it is not practiced regularly. The pleasure doing
      physical exercises and the possibility of integrating them into daily life are important
      factors of adherence. Gardening meets well the expectations of the physical treatment of
      chronic low back pain as it involves exercises aiming to increase spinal flexibility,
      strength and endurance of spine and lower limbs muscles, proprioception. Gardening is
      associated with the notion of pleasure and can be practiced in a group thus promoting the
      social bond. Moreover, therapeutic horticulture is suitable for the long term and can even be
      practiced in urban environment. Painful sensations are modulated by the affective and
      emotional state. Within the neuromatrix of pain, the cortex plays an important role in
      encoding pain and associated emotions. Several studies suggest an impact on several
      physiological parameters of an "experience of nature", even on a short time. A randomized
      controlled trial compared in 38 healthy volunteers, the effect of a 90-minute walk in nature
      (forest) and in urban setting (city), on the activation of the anterior cingulate cortex
      (specifically its subgenual part) assessed using variation in blood perfusion on MRI, and on
      rumination, assessed using a self-administered questionnaire. The authors showed that neural
      activation in the subgenual prefrontal cortex and rumination scores were lower in the group
      of healthy volunteers exposed to nature. Little is known about the impact of a "nature
      experience" on chronic low back pain. A non-randomized controlled study has shown that adding
      7 sessions of therapeutic horticulture to a standardized pain management program improved
      health status, anxiety and coping strategies in patients with chronic pain.

      By its nature and physical component, therapeutic horticulture could constitute a
      non-pharmacological accurate intervention in people with chronic low back pain, targeting
      both the neurobiological and physical aspects of deconditioning syndrome. Therapeutic
      horticulture was introduced in October 2017 in the multidisciplinary training program
      dedicated to chronic low back pain in our department. However, its effects have not yet been
      evaluated.
    

Intervention name(s): Physical activity involving exposure to nature: Therapeutic horticulture
Intervention type(s): Other
Intervention description(s): 2 sessions of 90 minutes of therapeutic horticulture and 2 sessions of 90 minutes of handiwork
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Basic Science
Keywords: Low back pain; Chronic pain; therapeutic horticulture; anterior cingulate cortex; subgenual prefrontal cortex