Therapeutic Effects of Horticulture on Anterior Cingulate Cortex Activation in People With Chronic Low Back Pain

NCT ID: NCT04656158

Last Updated: 2025-11-20

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 16 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2021-05-25
• Study Completion Date: 2022-03-29

Brief 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.

Conditions

Low Back Pain

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: CROSSOVER
• Primary Study Purpose: BASIC_SCIENCE
• Blinding Strategy: SINGLE

Study Groups

Therapeutic horticulture

handling (gardening equipment) and gardening task (outdoor and greenhouse tasks)

Group Type: EXPERIMENTAL

Physical activity involving exposure to nature: Therapeutic horticulture

Intervention Type: OTHER

2 sessions of 90 minutes of therapeutic horticulture and 2 sessions of 90 minutes of handiwork

Handiwork

Handling tasks (materials) and handiwork (manufacturing of piece of wooden furniture)

Group Type: ACTIVE_COMPARATOR

Physical activity involving exposure to nature: Therapeutic horticulture

Intervention Type: OTHER

2 sessions of 90 minutes of therapeutic horticulture and 2 sessions of 90 minutes of handiwork

Interventions

Physical activity involving exposure to nature: Therapeutic horticulture

2 sessions of 90 minutes of therapeutic horticulture and 2 sessions of 90 minutes of handiwork

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Adults of working-age (18 to 70 years),
• Chronic non-specific low back pain,
• Patient waiting for a short functional restoration program in the rehabilitation department,
• Failure of first-line treatment,
• Up-to-date DTP vaccination,
• Patients able to walk 2 km,
• Health insurance,
• Informed written consent.

Exclusion Criteria

• Specific low back pain,
• Contraindication to MRI,
• Current stoppage or for more than 3 months during the last year,
• Lack of paid employment,
• Participation in another research on low back pain,
• Inability to fluently speak and/or read French language,
• Free state medical assistance
• People under tutorship or curatorship, and protected adults.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 70 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

URC-CIC Paris Descartes Necker Cochin

OTHER

Sponsor Role: collaborator

Assistance Publique - Hôpitaux de Paris

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Christelle NGUYEN, MD, PhD

Role: STUDY_DIRECTOR

Assistance Publique - Hôpitaux de Paris

Locations

Cochin hospital - Department of Physical and Rehabilitation Medicine,

Paris, , France

Countries

France

References

Roren A, Debacker C, Saghiah M, Bedin C, Fayolle A, Abdoul H, Lefevre-Colau MM, Rannou F, Oppenheim C, Nguyen C. Effects of horticultural therapy versus handiwork on anterior cingulate cortex activity in people with chronic low back pain: A randomized, controlled, cross-over, pilot study. PLoS One. 2024 Dec 17;19(12):e0313920. doi: 10.1371/journal.pone.0313920. eCollection 2024.

Reference Type: RESULT

PMID: 39689109 (View on PubMed)

Other Identifiers

2019-A02988-49

Identifier Type: REGISTRY

Identifier Source: secondary_id

APHP191119

Identifier Type: -

Identifier Source: org_study_id