title: Do cerebral potentials to magnetic stimulation of paraspinal muscles reflect changes in palpable muscle spasm, low back pain, and activity scores?
abstract: OBJECTIVE
  Previous studies have shown that cortical-evoked potentials on magnetic stimulation of muscles are influenced by muscle contraction, vibration, and muscle spasm. This study was carried out to determine whether these potentials correlate with palpatory muscle spasm, patient symptoms, and disability in patients with low back pain.
  
  
  METHODS
  A prospective observational study was performed on 13 subjects with a history of low back pain visiting an orthopedic hospital-based clinic. Patients were screened for serious pathologic conditions by an orthopedic surgeon. The patients were then evaluated for the presence of muscle spasm by one of the investigators who was blinded to the results of the evoked potential studies. Patients were asked to complete a low back pain visual analogue scale (VAS) and a Roland-Morris Activity Scale (RMAS). Cortical-evoked potentials were recorded with a magnetic stimulator placed over the lumbar paraspinal muscles with the patient in the prone position. The palpatory examination, VAS, RMAS, and the cortical potentials were repeated after 2 weeks of therapy commonly used to reduce muscle spasm.
  
  
  RESULTS
  The patients demonstrated a significant decrease in low back pain VAS and RMAS scores after treatment compared with before treatment. There was a reduction in the amount of palpatory muscle spasm in 11 of 13 cases. The cortical potentials before treatment were attenuated compared with previously reported controls and showed a significant increase before and after treatment in the amplitude of these potentials with multivariate analysis of variance. There was significant correlation between the changes in cortical potentials after treatment and the changes noted in paraspinal muscle spasm and VAS and RMAS scores.
  
  
  CONCLUSIONS
  This study confirms the previous report that the amplitude of cerebral-evoked potentials on magnetic stimulation of paraspinal muscles is depressed in the presence of palpable muscle spasm. The close correlation among these potentials, paraspinal muscle spasm, and clinical symptoms suggests that the measurement of muscle activity may be more important in the assessment of low back pain than is commonly accepted.
authors.affiliation: Department of Neurology, University of California, Irvine, Irvine, Calif., USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Zhu
authors.forename: S
authors.initials: S
authors.lastname: Haldeman
authors.forename: C Y
authors.initials: CY
authors.lastname: Hsieh
authors.forename: P
authors.initials: P
authors.lastname: Wu
authors.forename: A
authors.initials: A
authors.lastname: Starr
mesh_terms: D000328:Adult; D000368:Aged; D001416:Back Pain / Q000628:therapy*; D005071:Evoked Potentials; D005260:Female; D006801:Humans; D008280:Magnetics / Q000627:therapeutic use*; D008297:Male; D020393:Manipulation, Spinal; D008875:Middle Aged; D018482:Muscle, Skeletal; D010147:Pain Measurement; D011446:Prospective Studies; D013035:Spasm / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome