Traditional Chinese Manual Therapy (Tuina) relieves neuropathic pain by regulating neuroplasticity: A resting-state functional magnetic resonance imaging study

Aims: o determine how traditional Chinese manual therapy (Tuina) alleviates neuropathic pain (NPP) via central neuroplasticity.Methods: NPP was induced by chronic compression of the dorsal root ganglion (CCD) in male rats. From post-operative day 4 to 28, Tuina (5 N, 2 Hz, 10 min/day) was applied at BL40. Behavioural tests (mechanical withdrawal threshold, MWT; paw withdrawal thermal latency, PWL) were performed on -2nd and -1st day before CCD surgery and 3rd, 7th, 14th, 21st and 28th day after CCD surgery. Resting-state functional magnetic resonance imaging were conducted before CCD surgery and 7th and 28th day after CCD surgery.Results: CCD surgery induced persistent mechanical and thermal allodynia. Tuina reversed these deficits from day 14 onward (p < 0.05). Compared with Sham, the CCD group exhibited elevated regional homogeneity (ReHo) in the hippocampus, amygdala, brainstem and cerebellum. Tuina further increased ReHo in the amygdala, hippocampus, corpus callosum and temporal lobe between days 7 and 28. ReHo values in pain-related regions negatively correlated with MWT and PWL (r = −0.23 to −0.44, p < 0.05).Conclusion: Tuina may gradually relieve neuropathic pain by reshaping limbic and sensory-motor networks, offering neuroplasticity-based rationale for its clinical use.