Chronic low back pain and sick-leave: a functional magnetic resonance study

Feitosa, Aloma A.; Amaro, Edson; Sanches, Liana Guerra; Borba, Eduardo F.; Jorge, Liliana Lourenço; Halpern, Ari Stiel Radu

doi:10.1186/s42358-020-00146-4

Cited by 5 publications

(4 citation statements)

References 31 publications

(37 reference statements)

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“…This study, however, observed that in patients with chronic pain following SCI, there was overall increased FC between the AI and PI and the frontal pole compared to HC. Other studies have pointed to the role that the prefrontal cortex organizes the affective component of pain with the AI 12,22 . Of note, those with major depressive disorder have been found to have increased FC of the AI with the frontal pole 23 .…”

Section: Discussionmentioning

confidence: 98%

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The role of the insula in chronic pain following spinal cord injury: A resting‐state fMRI study

Mandloi,

Syed,

Shoraka

et al. 2023

Journal of Neuroimaging

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Background and PurposeSpinal cord injury (SCI) results in the loss of motor and sensory function from disconnections between efferent and afferent pathways. Most SCI patients are affected with chronic neuropathic pain, but there is a paucity of data concerning neuroplastic changes following SCI. Chronic pain disrupts default networks and is associated with abnormal insular connectivity. The posterior insula (PI) is associated with the degree of pain and intensity of pain. The anterior insula (AI) is related to signal changes. Comprehension of SCI pain mechanisms is essential to elucidate effective treatment options.MethodsThis study examines the insular gyri functional connectivity (FC) of seven (five male, two female) SCI participants with moderate‐severe chronic pain compared to 10 (five male, five female) healthy controls (HC). All subjects had 3‐Tesla MRI performed and resting‐state functional MRI (fMRI) was acquired. FC metrics were obtained from the comparisons of resting‐state fMRI among our various groups. A seed‐to‐voxel analysis was pursued, encompassing six gyri of the insula. For multiple comparisons, a correction was applied with a significance level of p < .05.ResultsThere were significant differences in FC of the insula between SCI participants with chronic pain compared with HC. In the SCI participants, there was hyperconnectivity of the AI and PI to the frontal pole. In addition, there was increased FC noted between the PI and the anterior cingulate cortex. Hyperconnectivity was also observed between the AI and the occipital cortex.ConclusionsThese findings illustrate that there is a complex hyperconnectivity and modulation of pain pathways after traumatic SCI.

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Section: Discussionmentioning

confidence: 98%

“…Other studies have pointed to the role that the prefrontal cortex organizes the affective component of pain with the AI. 12,22 Of note, those with major depressive disorder have been found to have increased FC of the AI with the frontal pole. 23 Patients with SCI are at increased risk for depression.…”

Section: Increased Fc Of the Ai And Pi With The Frontal Polementioning

confidence: 99%

The role of the insula in chronic pain following spinal cord injury: A resting‐state fMRI study

Mandloi,

Syed,

Shoraka

et al. 2023

Journal of Neuroimaging

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“…Involvement of lateral frontal pole in pain perception is well established in several neuroimaging and magnetic stimulation studies. [70][71][72] Thus, we examined changes in the overall top-down and bottom-up effective connectivity -with pain perception and placebo response -by selecting nodes at both the highest and lowest levels of the cortical hierarchy in the pain processing pathway.…”

Section: Discussionmentioning

confidence: 99%

The functional anatomy of nociception: effective connectivity in chronic pain and placebo responders

Nara,

Baliki,

Friston

et al. 2024

Preprint

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There is growing recognition of cortical involvement in nociception. The present study is motivated by predictive coding formulations of pain perception that stress the importance of top-down and bottom-up information flow in the brain. It compares forward and backward effective connectivity - estimated from resting-state fMRI - between chronic osteoarthritic patients and healthy control subjects. Additionally, it assesses differences in effective connectivity between placebo responders and non-responders and asks whether these differences can be used to predict pain perception and placebo response. To assess hierarchical processing in nociception, we defined two primary cortical regions: primary somatosensory cortex (SSC) and posterior insula (PI) (primary interoceptive cortex) and lateral frontal pole (FP1), a terminal relay station of the pain processing pathways. The directed (effective) connectivity within and between these regions were estimated using spectral dynamic causal modeling (DCM). 56 osteoarthritis patients and 18 healthy controls were included in the analysis. Within the patient group, effective connectivity was compared between placebo responders and non-responders. In osteoarthritic patients, contra control group, forward connectivity from SSC to FP1 and from PI to FP1 was enhanced in the left hemisphere. Backward connections from FP1 to SSC were more inhibitory. Intrinsic (i.e., inhibitory recurrent or self-connectivity) of left FP1 increased. In placebo responders compared to non-responders, forward connections from bilateral SSC to PI, left SSC to FP1, left PI to left FP1 were more inhibitory. In addition, self-connections of bilateral PI and top-down connections from right FP1 to right SSC were disinhibited; whereas self-connections of right FP1 became increasingly inhibitory. We confirmed the robustness of these results in a leave-one-out cross-validation analysis of (out-of-sample) effect sizes. Overall, effective extrinsic and intrinsic effective connectivity among higher and lower cortical regions involved in pain processing emerges as a promising and quantifiable candidate marker of nociception and placebo response. The significance of these findings for clinical practice and neuroscience are discussed in relation to predictive processing accounts of placebo effects and chronic pain.

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“…In addition, patients with irritable bowel syndrome (IBS) display increased activity in the ACC, IC, and prefrontal cortex (PFC) [ 23 ]. Chronic low back pain (CLBP) causes hyperalgesia associated with increased ACC activity and altered functional connectivity, as well as decreased gray matter density in the ACC, PFC, thalamus, brainstem, and somatosensory cortex [ 24 , 25 ]. In cases of fibromyalgia (FM), overall gray matter volume is unchanged but may differ in distribution when comparing healthy to FM patients.…”

Section: Human Studies Of Acc and Icmentioning

confidence: 99%

Synaptic Plasticity in the Pain-Related Cingulate and Insular Cortex

2022

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Cumulative animal and human studies have consistently demonstrated that two major cortical regions in the brain, namely the anterior cingulate cortex (ACC) and insular cortex (IC), play critical roles in pain perception and chronic pain. Neuronal synapses in these cortical regions of adult animals are highly plastic and can undergo long-term potentiation (LTP), a phenomenon that is also reported in brain areas for learning and memory (such as the hippocampus). Genetic and pharmacological studies show that inhibiting such cortical LTP can help to reduce behavioral sensitization caused by injury as well as injury-induced emotional changes. In this review, we will summarize recent progress related to synaptic mechanisms for different forms of cortical LTP and their possible contribution to behavioral pain and emotional changes.

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Chronic low back pain and sick-leave: a functional magnetic resonance study

Cited by 5 publications

References 31 publications

The role of the insula in chronic pain following spinal cord injury: A resting‐state fMRI study

The role of the insula in chronic pain following spinal cord injury: A resting‐state fMRI study

The functional anatomy of nociception: effective connectivity in chronic pain and placebo responders

Synaptic Plasticity in the Pain-Related Cingulate and Insular Cortex

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