Abstract
Background
Chronification of pain is associated with both anatomical and functional alterations of the brain. Alteration in regional gray matter volume might potentially be associated with modified activity of specific brain networks. In this cross-sectional, observational study, we sought to identify brain regions with gray matter volume changes in patients with chronic pain and to reveal its significance by analysing alteration in functional connectivity from those regions. We further explored relevance of such alterations with psychometrics of chronic pain.
Methods
We recruited 23 patients with chronic pain and 17 age-, gender-matched healthy control subjects. After completing multiple psychophysical questionnaires, each subject underwent resting-state functional magnetic resonance imaging and 3-dimensional anatomical imaging on a 3 Tesla magnetic resonance imaging scanner.
Results
Patients with chronic pain showed significant volume decrease at the right anterior insular cortex (p<0.001) and the left middle cingulate cortex (p<0.001) compared with healthy controls. They also showed decreased connectivity between the right anterior insular cortex and the left nucleus accumbens in negative association with the Pain Catastrophizing Scale (R2=0.20, p=0.046) and the Beck's Depression Inventory scores (R2=0.24, p=0.017).
Conclusions
Decreased gray matter volumes of those core regions for affective processing of pain might be a common cerebral feature shared by, at least some of, different aetiologies of chronic pain. Dysfunctional network between the anterior insular cortex and the nucleus accumbens might reflect affective and motivational disability involved in chronic pain. Such anatomical and functional profiles could potentially be part of a cerebral signature for chronification of pain.
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