Background/Purpose:   Fibromyalgia (FM) is a common and complex musculoskeletal pain syndrome with unsatisfactory treatment options. Studies suggest that Tai Chi mind-body exercise may be a promising treatment for Fibromyalgia. However, the underlying mechanism of Tai Chi remains unclear. Previous studies suggest that Tai Chi may modulate individuals’ cognitive function which interacts reciprocally with pain. Thus, in this pilot brain imaging study, we first compared the resting-state functional connectivity (rsFC) of the cognitive control network (CCN) of FM patients to that of the matched healthy controls, and further examined how Tai Chi practice can modulate the CCN rsFC in relation to clinical outcomes.

Methods:   We conducted a 3-month, non-randomized comparison trial of Tai Chi for participants with FM (ACR 1990 and 2010 criteria) vs. healthy controls. The 60-minute group sessions occurred twice-weekly. Each subject participated in two identical fMRI scanning sessions at baseline (Scan 1) and 3 months (Scan 2) after the end of Tai Chi intervention. Using a 3T Siemens MRI system, 8-minute resting state fMRI data were collected. Healthy matched controls were scanned only once. We also administered the Revised Fibromyalgia Impact Questionnaire (FIQR) before and after each fMRI scan. Seed-based rsFC was analyzed with CONN (https://www.nitrc.org/projects/conn/). Bilateral dorsolateral prefrontal cortex (DLPFC) was applied as the seed to explore the rsFC of cognitive control network. A threshold of voxelwise p< 0.005 and p< 0.05 Family-Wise Error (FEW) correction was applied for rsFC analysis.

Results:   Twenty-one participants with FM and 20 age, gender, and BMI-matched healthy controls completed the study. One individual with FM and 1 healthy control were excluded from the rsFC analysis due to excessive head movement during scan. After Tai Chi interventions, there was a significant decrease in the total FIQR score (mean ± SD, pre: 45.7 ± 18.3, post: 36.4 ± 21, p < 0.001) and the three FIQR domains: Function (pre: 12.2 ± 6.1, post: 8.5 ± 6.4, p< 0.001), Overall Impact (pre: 8.9 ± 6.2, post: 7.0±5.7 p<0.05), and Symptom (pre: 25.4 ± 8.3, post: 20.9 ± 11.7, p< 0.02). Analysis of CCN rsFC showed that compared to matched healthy controls, FM patients were found to have significantly greater rsFC between DLPFC and bilateral rostral anterior cingulate cortex (rACC) / medial prefrontal cortex (MPFC), and the left precentral gyrus. In addition, we found 1) significant increase in the DLPFC rsFC at left rACC / MPFC after Tai Chi practice, and 2) a significant positive association (p = 0.026) between the baseline cluster Fisher z values at rACC/MPFC and corresponding cognitive performance, measured by the FIQR Overall Impact subscores after controlling for age at baseline.

Conclusion:   Our results suggest that Tai Chi practice can significantly increase rsFC between the CCN and rACC / MPFC over 12 weeks in patients with FM. Our study further implies that Tai Chi may achieve clinical improvement by strengthening the cognitive control / adaption / coping process in individuals with FM. Elucidation of the mechanism will open a new window for FM management.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/tai-chi-significantly-modulates-resting-state-functional-connectivity-of-the-cognitive-control-network-in-fibromyalgia/