Brain structural alterations associated with dysfunctional cognitive control of pain in patients with low back pain

Chehadi, Omar; Rusu, Adina C.; Konietzny, Kerstin; Schulz, Enrico; Köster, O.; Schmidt‐Wilcke, Tobias; Hasenbring, Monika

doi:10.1002/ejp.1159

Cited by 13 publications

(11 citation statements)

References 57 publications

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“…However, these symptoms might suggest involvement of limbic or temporal structures in VSS. The hypometabolism of the superior temporal gyrus found in our study is in agreement with its role for irritability ( Besteher et al , 2017 ) and for thought suppression of pain ( Chehadi et al , 2018 ). The latter study further demonstrated involvement of the middle temporal gyrus in cognitive pain control, an area that also exhibited grey matter volume increase in VSS.…”

Section: Discussionsupporting

confidence: 90%

Structural and functional footprint of visual snow syndrome

Schankin

Maniyar

Chou

et al. 2020

Brain

139

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Patients with visual snow syndrome suffer from a continuous pan-field visual disturbance, additional visual symptoms, tinnitus, and non-perceptional symptoms. The pathophysiology of visual symptoms might involve dysfunctional visual cortex. So far, the extra-visual system has not been investigated. We aimed at identifying structural and functional correlates for visual and non-visual symptoms in visual snow syndrome. Patients were compared to age- and sex-matched controls using 18F-2-fluoro-2-deoxy-d-glucose PET (n = 20 per group) and voxel-based morphometry (n = 17 per group). Guided by the PET results, region of interest analysis was done in voxel-based morphometry to identify structural-functional correspondence. Grey matter volume was assessed globally. Patients had corresponding hypermetabolism and cortical volume increase in the extrastriate visual cortex at the junction of the right lingual and fusiform gyrus. There was hypometabolism in the right superior temporal gyrus and the left inferior parietal lobule. Patients had grey matter volume increases in the temporal and limbic lobes and decrease in the superior temporal gyrus. The corresponding structural and functional alterations emphasize the relevance of the visual association cortex for visual snow syndrome. The broad structural and functional footprint, however, confirms the clinical impression that the disorder extends beyond the visual system.

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Section: Discussionsupporting

confidence: 90%

Structural and functional footprint of visual snow syndrome

Schankin

Maniyar

Chou

et al. 2020

Brain

139

View full text Add to dashboard Cite

show abstract

“…Congruently, a strong link between negative beliefs and increased pain perception has been shown in several studies of chronic LBP patients [ 57 ]. In addition, chronic LBP can lead to functional alterations in the circuitry underlying the cognitive control of pain [ 11 ]. The link between pain-related thought suppression and brain morphology may provide a new perspective on the understanding of the cognitive control of pain in chronic LBP, which may help improve the outcomes of cognitive behavioral therapy [ 11 ].…”

Section: Resultsmentioning

confidence: 99%

Behavioral Therapy Approaches for the Management of Low Back Pain: An Up-To-Date Systematic Review

et al. 2018

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Low back pain is one of the most common causes for seeking medical treatment and it is estimated that one in two people will experience low back pain at some point during their lifetimes. Management of low back pain includes pharmacological and non-pharmacological approaches. Non-pharmaceutical treatments include interventions such as acupuncture, spinal manipulation, and psychotherapy. The latter is especially important as patients who suffer from low back pain often have impaired quality of life and also suffer from depression. Depressive symptoms can appear because back pain limits patients’ ability to work and engage in their usual social activities. The aim of this systematic review was to overview the behavioral approaches that can be used in the management of patients with low back pain. Approaches such as electromyography (EMG) biofeedback, cognitive behavioral therapy, and mindfulness-based stress reduction are discussed as non-pharmacological options in the management of low back pain.

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“…[2][3][4] Chronic NS-LBP can have a long and tedious treatment that often is not a straightforward process. Psychosocial factors have been well established to have an association with chronic LBP [5][6][7] as has the advocation for including strategies to address these factors during treatment, even in athletes. 8 The lack of structural deformity or tissue damage associated with chronic NS-LBP can leave both the patients and the clinicians frustrated with the slow rehabilitation process.…”

Section: Clinical Scenariomentioning

confidence: 99%

Pain Education With Therapeutic Exercise in Chronic Nonspecific Low Back Pain Rehabilitation: A Critically Appraised Topic

Jones¹,

Tocco²,

Marshall³

et al. 2020

Journal of Sport Rehabilitation

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Clinical Scenario: Low back pain is widely prevalent in the general population as well as in athletes. Therapeutic exercise is a low-risk and effective treatment option for chronic pain that can be utilized by all rehabilitation clinicians. However, therapeutic exercise alone does not address the psychosocial aspects that are associated with chronic low back pain. Pain education is the umbrella term utilized to encompass any type of education to the patient about their chronic pain. Therapeutic exercise in combination with pain education may allow for more well-rounded and effective treatment for patients with chronic nonspecific low back pain (NS-LBP). Clinical Question: Does pain education combined with therapeutic exercise, compared with therapeutic exercise alone, improve patient pain in adults with chronic NS-LBP over a 2- to 3-month treatment period? Summary of Key Findings: A thorough literature review yielded 8 studies potentially relevant to the clinical question, and 3 studies that met the inclusion criteria were included. The 3 studies included reports that exercise therapy reduced symptoms. Two of the 3 included studies support the claim that exercise therapy reduces the symptoms of chronic NS-LBP when combined with pain education, whereas one study found no difference between pain education with therapeutic exercise. Clinical Bottom Line: There is moderate evidence to support the use of pain education along with therapeutic exercise when attempting to reduce symptoms of pain and disability in patients with chronic NS-LBP. Educational interventions should be created to educate patients about the foundation of pain, and pain education should be implemented as a part of the clinician’s strategy for the rehabilitation of patients with chronic NS-LBP. Strength of Recommendation: Grade B evidence exists to support the use of patient education with therapeutic exercise for decreasing pain in patients with chronic NS-LBP.

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Brain structural alterations associated with dysfunctional cognitive control of pain in patients with low back pain

Abstract: The link between pain-related thought suppression and brain morphology may provide a new perspective on the understanding of cognitive control of pain in chronic low back pain, which may help improve cognitive behavioural therapy.

Cited by 13 publications

References 57 publications

Structural and functional footprint of visual snow syndrome

Structural and functional footprint of visual snow syndrome

Behavioral Therapy Approaches for the Management of Low Back Pain: An Up-To-Date Systematic Review

Pain Education With Therapeutic Exercise in Chronic Nonspecific Low Back Pain Rehabilitation: A Critically Appraised Topic

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