White Matter Involvement in Chronic Musculoskeletal Pain

Abstract

There is emerging evidence that chronic musculoskeletal pain is associated with anatomical and functional abnormalities in gray matter. However, little research has investigated the relationship between chronic musculoskeletal pain and white matter (WM). In this study, we used whole-brain tract-based spatial statistics, and region-of-interest analyses of diffusion tensor imaging (DTI) data to demonstrate that patients with chronic musculoskeletal pain exhibit several abnormal WM integrity as compared to healthy controls. Chronic musculoskeletal pain was associated with lower fractional anisotropy (FA) in the splenium of corpus callosum, and left cingulum adjacent to the hippocampus. Patients also had higher radial diffusivity (RD) in the splenium, right anterior and posterior limbs of internal capsule, external capsule, superior longitudinal fasciculus, and cerebral peduncle. Patterns of axial diffusivity (AD) varied: patients exhibited lower AD in the left cingulum adjacent to the hippocampus and higher AD bilaterally in the anterior limbs of internal capsule, and in the right cerebral peduncle. Several correlations between diffusion metrics and clinical variables were also significant at a p<0.01 level: FA in the left uncinate fasciculus correlated positively with Total Pain Experience and typical levels of pain severity. AD in the left anterior limb of internal capsule and left uncinate fasciculus were correlated with Total Pain Experience and typical pain level. Positive correlations were also found between AD in the right uncinate and both Total Pain Experience and Pain Catastrophizing. These results demonstrate that WM abnormalities play a role in chronic musculoskeletal pain; either as a cause, predisposing factor, consequence, or compensatory adaptation.

White matter integrity associated with clinical symptoms in tinnitus patients: A tract-based spatial statistics study

“…Symbols are scaled to age to demonstrate the independent nature of these findings. The partial correlation coefficient between FA, MD and radial diffusivity values and BDI is −0.6279, 0.6092 and 0.6177, respectively (p<0.05, adjusted for age and gender) studies have reported that increased axial diffusivity was associated with chronic pain or hyperalgeria [18,19]. This voxel-based regional change in the present study is the confirmatory finding that supports a previous ROI study that also showed a difference in DTI values in the auditory cortices of tinnitus patients compared with normal control subjects [6].…”

Differences in white matter structure and cortical thickness between patients with traumatic and idiopathic chronic neck pain: Associations with cognition and pain modulation?

“…The tapetum is the temporal component of the corpus callosum (Mori et al, ) formed by decussating fibers in the splenium that arch over the atrium of the lateral ventricle and course inferiorly in the posterior and temporal horns of this ventricle (Sarikcioglu et al, ). In contrast, more evidence exists for WM deficits in the corpus callosum (genu, rostrum, body, splenium, tapetum) in chronic musculoskeletal pain patients (Lieberman et al, ) and mild TBI patients (Xiong et al, ).…”

“…Association fibers, namely (6) the cingulum cingulate gyrus (i.e., subgenual and retrosplenial part of the cingulum) and (7) the cingulum hippocampus (i.e., parahippocampal part of the cingulum) (Lieberman et al, ; Mori et al, ) and (8) fornix and stria terminalis (Borsook et al, ; Chen et al, ; Upadhyay et al, ). Finally, commissural fibers, that is (9) the tapetum of the corpus callosum (Kim et al, ; McAllister, ) and (10) the splenium of the corpus callosum (Lieberman et al, ). Acceleration–deceleration of the brain is believed to affect the superior cerebellar peduncles, and periventricular WM (McAllister, ), for example, tapetum of the corpus callosum (Kim et al, ; Sarikcioglu et al, ; Todd & Lempert, ).…”

Brain white matter plasticity and functional reorganization underlying the central pathogenesis of trigeminal neuralgia

“…The inferior fronto-occipital fasciculus links cortical regions involved in the processing of pain, emotion, and rewards27. Diffusion alterations in the uncinate fasciculus have been correlated with pain experience and perception28. Microstructural alterations of the anterior thalamic radiation and cingulated gyrus connect cortical regions also involved in body perception.…”