Chronic Back Pain Is Associated With Decreased Prefrontal and Anterior Insular Gray Matter: Results From a Population-Based Cohort Study

Fritz, Hans-Christian; McAuley, James H.; Wittfeld, Katharina; Hegenscheid, Katrin; Schmidt, Carsten Oliver; Langner, Sönke; Lotze, Martín

doi:10.1016/j.jpain.2015.10.003

Cited by 115 publications

(101 citation statements)

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“…Although the underlying mechanisms of microstructural changes in the brain gray matter of patients with chronic pain remain unclear, neuroimaging studies have demonstrated an apparent reduction in the density or volume of these patients’ gray matter (Obermann et al, 2013; Wilcox et al, 2015; Fritz et al, 2016; Krause et al, 2016). One report even showed that the degree of reduction is compatible with a natural decline occurring over 10–20 years under normal conditions (Apkarian et al, 2004).…”

Section: Discussionmentioning

confidence: 99%

“…The ACC and mPFC are mainly involved in the multifunctional integration associated with pain, including pain perception and attention, emotional responses to pain, pain intensity, and anticipation of pain (Alkire et al, 2004; Ji et al, 2010). It has been reported that in patients with trigeminal nerve pain, the volume of the gray matter in the ACC is negatively correlated with the course of the disease (Obermann et al, 2013); in patients with central post-stroke pain (CPSP), the volume of the gray matter in the prefrontal cortex is negatively correlated with pain intensity (Krause et al, 2016); and in patients with chronic low back pain, the volume of the gray matter in the prefrontal cortex and AAC is negatively correlated with pain intensity (Fritz et al, 2016). Here, our data indicated that the course of the disease and pain intensity play crucial roles in the microstructural alterations of gray matter in patients with MTrPs-related chronic pain, and the gray matter microstructures in the ACC and mPFC are more vulnerable to these impacts.…”

Section: Discussionmentioning

confidence: 99%

“…The brain gray matter is closely associated with the body’s pain perception (Cauda et al, 2014; Emerson et al, 2014). A large body of evidence indicated that the gray matter might exhibit abnormalities under chronic pain status, such as trigeminal neuralgia (Obermann et al, 2013; Li et al, 2016), chronic low back pain (Seminowicz et al, 2011; Fritz et al, 2016), fibromyalgia (Hsu et al, 2009; Robinson et al, 2011), phantom limb pain (Preissler et al, 2013), cyclic menstrual pain (Tu et al, 2010), complex regional pain syndrome (Geha et al, 2008), and migraine (Magon et al, 2015). In addition, the density and volume changes of gray matter in patients with chronic pain are also related to clinical traits (Apkarian et al, 2004; Kuchinad et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

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Microstructural Abnormalities Were Found in Brain Gray Matter from Patients with Chronic Myofascial Pain

et al. 2016

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Myofascial pain, presented as myofascial trigger points (MTrPs)-related pain, is a common, chronic disease involving skeletal muscle, but its underlying mechanisms have been poorly understood. Previous studies have revealed that chronic pain can induce microstructural abnormalities in the cerebral gray matter. However, it remains unclear whether the brain gray matters of patients with chronic MTrPs-related pain undergo alteration. In this study, we employed the Diffusion Kurtosis Imaging (DKI) technique, which is particularly sensitive to brain microstructural perturbation, to monitor the MTrPs-related microstructural alterations in brain gray matter of patients with chronic pain. Our results revealed that, in comparison with the healthy controls, patients with chronic myofascial pain exhibited microstructural abnormalities in the cerebral gray matter and these lesions were mainly distributed in the limbic system and the brain areas involved in the pain matrix. In addition, we showed that microstructural abnormalities in the right anterior cingulate cortex (ACC) and medial prefrontal cortex (mPFC) had a significant negative correlation with the course of disease and pain intensity. The results of this study demonstrated for the first time that there are microstructural abnormalities in the brain gray matter of patients with MTrPs-related chronic pain. Our findings may provide new insights into the future development of appropriate therapeutic strategies to this disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Microstructural Abnormalities Were Found in Brain Gray Matter from Patients with Chronic Myofascial Pain

et al. 2016

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“…Chronic pain states such as chronic low back pain and sympathetically mediated chronic pain were found to be associated with hyperactivity in the mPFC including the DMPFC (Apkarian et al, 2001; Baliki et al, 2008). On the other hand, the dorsolateral PFC is implicated in inhibition of pain perception (Lorenz et al, 2003; Brighina et al, 2004), and gray matter atrophy in this brain region was reported in patients with chronic neck pain with MTrP and chronic low back pain (Fritz et al, 2016; Niddam et al, 2017). These findings suggest that unbalanced activity within the PFC might be associated with chronic pain.…”

Section: Discussionmentioning

confidence: 99%

Compression at Myofascial Trigger Point on Chronic Neck Pain Provides Pain Relief through the Prefrontal Cortex and Autonomic Nervous System: A Pilot Study

et al. 2017

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Compression at myofascial trigger points (MTrPs), known as “ischemic compression,” has been reported to provide immediate relief of musculoskeletal pain and reduce the sympathetic activity that exacerbates chronic pain. We conducted a pilot study to investigate the possible involvement of the prefrontal cortex in pain relief obtained by MTrP compression in the present study, and analyzed the relationships among prefrontal hemodynamic activity, activity of the autonomic nervous system, and subjective pain in patients with chronic neck pain, with and without MTrP compression. Twenty-one female subjects with chronic neck pain were randomly assigned to two groups: MTrP compression (n = 11) or Non-MTrP compression (n = 10). Compression for 30 s was conducted 4 times. During the experiment, prefrontal hemodynamic activity [changes in Oxy-hemoglobin (Hb), Deoxy-Hb, and Total-Hb concentrations] and autonomic activity based on heart rate variability (HRV) were monitored by using near infrared spectroscopy (NIRS) and electrocardiography (ECG), respectively. The results indicated that MTrP compression significantly reduced subjective pain compared with Non-MTrP compression. The spectral frequency-domain analyses of HRV indicated that a low frequency (LF) component of HRV was decreased, and a high frequency (HF) component of HRV was increased during MTrP compression, while LF/HF ratio was decreased during MTrP compression. In addition, prefrontal hemodynamic activity was significantly decreased during MTrP compression compared with Non-MTrP compression. Furthermore, changes in autonomic activity were significantly correlated with changes in subjective pain and prefrontal hemodynamic activity. Along with previous studies indicating a role for sympathetic activity in the exacerbation of chronic pain, the present results suggest that MTrP compression in the neck region alters the activity of the autonomic nervous system via the prefrontal cortex to reduce subjective pain.

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“…Findings from these studies were inconsistent, with some reporting smaller volumes in participants with chronic LBP compared to healthy controls, and others reporting no differences in brain volume. Importantly, the sample sizes in these studies were modest, and many that reported significance differences in brain volume did not correct for multiple comparisons(37, 40, 41), drawing into question the significance of the observation. Moreover, only one study has addressed subacute LBP in terms of brain structure and whether such potential differences exist during earlier stages of the disease(43) is unclear.…”

Section: Introductionmentioning

confidence: 97%

Structural Brain Imaging in People With Low Back Pain

Mansour

Lepping

Honea

et al. 2017

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Study Design cross-sectional study Objective The aim of this study was to determine whether low back pain (subacute and chronic) is related to differences in brain volume. Summary of Background Data Inconsistent findings have been reported about the effect of chronic low back pain on brain volume, and the effect of subacute low back pain on brain volume has not been sufficiently investigated. Methods 130 participants were included (23 subacute and 68 chronic low back pain; 39 healthy controls). The main outcome measure was whole and regional brain volume. Clinical outcome measures included pain duration, pain intensity, fear avoidance belief questionnaire, Oswestry disability index, and Beck’s depression inventory. Results Decrease in brain volume in several regions was observed in chronic low back pain when compared to health subjects; however after correcting for multiple comparisons, no significant differences were detected between any of the 3 groups in whole-brain volume. Regionally, we detected less gray matter volume in 2 voxels in the middle frontal gyrus in chronic low back pain participants compared to healthy controls. None of the clinical outcome measures were correlated with brain volume measurements. Conclusion Low back pain (subacute or chronic) is not related to significant differences in brain volume after correction for multiple comparisons. The effect size was too small to detect possible subtle changes unless much larger sample sizes are examined, or it is possible that low back pain does not affect brain volume.

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Chronic Back Pain Is Associated With Decreased Prefrontal and Anterior Insular Gray Matter: Results From a Population-Based Cohort Study

Cited by 115 publications

References 50 publications

Microstructural Abnormalities Were Found in Brain Gray Matter from Patients with Chronic Myofascial Pain

Microstructural Abnormalities Were Found in Brain Gray Matter from Patients with Chronic Myofascial Pain

Compression at Myofascial Trigger Point on Chronic Neck Pain Provides Pain Relief through the Prefrontal Cortex and Autonomic Nervous System: A Pilot Study

Structural Brain Imaging in People With Low Back Pain

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