Immedicate Effects of Core Stabilization Exercise on β-Endorphin and Cortisol Levels Among Patients With Chronic Nonspecific Low Back Pain: A Randomized Crossover Design

Objective: Core stabilization exercise (CSE) is widely prescribed to treat chronic non-specific low back pain (CLBP). However, the neuro-endogenous mechanism behind the pain relieving effect by CSE is still unknown. The main objective of the study was to measure the levels of plasma beta-endorphin (PB) and plasma cortisol (PC) under CSE, placebo and control conditions in CLBP patients. Methods: Twenty-four subjects with CLBP participated in a randomized, placebo-controlled, cross-over design study. There were 3 experimental exercise conditions; control condition (positioning in crook lying and rest), placebo condition (passive cycling in crook lying using automatic cycler), and CSE on a Pilates device tested with 48 hours interval between sessions by concealed randomization. Blood sample was collected before and after the exercise conditions. PB and PC were measured through enzyme-linked immunosorbent assay and electrochemiluminescence in Cobas E411 auto analyzer. Result: PB level showed a significant difference before and after the CSE condition (P<0.05), while no significant differences were noticed in control and placebo exercise conditions. Also, the trend of elevation of PB under the CSE was significantly different when compared to the placebo and control conditions (P<0.01). In contrast, the PC level remains unchanged in all the three conditions. Conclusion: CSE potentially influences PB level but not PC level among CLBP patients. The mechanism of action for pain relieving effect by CSE might be possibly related to an endogenous opioid mechanism as part of its effects, and might not be involved with ‘stress induced analgesia mechanism.