Chronic pain in children: structural and resting-state functional brain imaging within a developmental perspective

Ravi R Bhatt, Arpana Gupta, Emeran A Mayer, Lonnie K Zeltzer, Ravi R Bhatt, Arpana Gupta, Emeran A Mayer, Lonnie K Zeltzer

Abstract

Chronic pain is a major public health problem in the United States costing $635 billion annually. Hospitalizations for chronic pain in childhood have increased almost tenfold in the past decade, without breakthroughs in novel treatment strategies. Findings from brain imaging studies using structural and resting-state fMRI could potentially help personalize treatment to address this costly and prevalent health problem by identifying the underlying brain pathways that contribute, facilitate, and maintain chronic pain. The aim of this review is to synthesize structural and resting-state network pathology identified by recent brain imaging studies in pediatric chronic pain populations and discuss the potential impact of chronic pain on cortical development. Sex differences as well as treatment effects on these cortical alterations associated with symptom changes are also summarized. This area of research is still in its infancy with currently limited evidence available from a small number of studies, some of which suffer from limitations such as small sample size and suboptimal methodology. The identification of brain signatures of chronic pain in children may help to develop new pathways for future research as well as treatment strategies.

Figures

Figure 1:
Figure 1:
Brain Networks Involved in Chronic Pain Key: Sensorimotor Network: M1: primary motor cortex, S1: primary somatosensory cortex, BG: basal ganglia, THAL: thalamus, posINS: posterior insula, Salience Network: mPFC: medial prefrontal cortex, aMCC: anterior mid-cingulate cortex, OFC: orbitofrontal cortex, aINS: anterior insula, Amyg: amygdala Central Executive Network: dlPFC: dorso-lateral prefrontal cortex, AnG: angular gyrus, PrCu: precuneus, Central Autonomic Network: mPFC: medial prefrontal cortex, OFC: orbitofrontal cortex, ACC: anterior cingulate cortex, aINS: anterior insula, Amyg: amygdala, Brainstem: brain stem Emotion Regulation Network: mPFC: medial prefrontal cortex, vlPFC: ventrolateral prefrontal cortex, ACC: anterior cingulate cortex Hipp: hippocampus, Amyg: amygdala Default Mode Network: mPFC: medial prefrontal cortex, PCC: posterior cingulate cortex, IPL: inferior parietal lobule, MTG: middle temporal gyrus

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